Internal carotid artery dissection following blunt head trauma: a pediatric case report and review of the literature

Interplay between carotid artery dissection and thrombophilia leading to ischaemic stroke after minor head trauma in an adolescent: a case report

Stroke in children is more common than is often realised; there are numerous potential causes, including carotid artery injury resulting from minor head or neck trauma, as well as genetic conditions associated with thrombophilia. A 13-year-old boy suffered an arterial ischaemic stroke (AIS) secondary to dissection of the left internal carotid artery (ICA) after he headed the ball during a game of football. He presented with generalised tonic-clonic seizure, loss of consciousness, right-sided hemiplegia and aphasia. Neuroradiological imaging showed left caudate, putaminal and posterior insular ischaemic infarct secondary to complete occlusion of the left ICA and accompanying partial left middle cerebral artery occlusion. He was treated with anticoagulant and anti-aggregant agents. Rarely, minor head trauma can result in internal carotid artery dissection, thrombus formation and arterial occlusion, leading to arterial ischaemic stroke. Prompt diagnosis and management are crucial to achieve a good neurological outcome.Abbreviations: AIS: arterial ischaemic stroke; ANA: anti-nuclear antibody; APA: anti-phospholipid antibody; APTT: activated partial thromboplastin time; CAD: carotid artery dissection; CCAD: cranio-cervical artery dissection; CRP: C-reactive protein; CT: computed tomography; CTA: computed tomography angiography; dsDNA: double-stranded DNA; ESR: erythrocyte sedimentation rate; ICA: internal carotid artery; LA: lupus anticoagulant; MCA: middle cerebral artery; MRA: magnetic resonance angiography; MRI: magnetic resonance imaging; MTHFR: methylenetetrahydrofolate reductase; PT INR: prothrombin time international normalised ratio.

Traumatic retroclival epidural hematoma associated with reversible ipsilateral internal carotid artery stenosis

INTRODUCTION

Traumatic retroclival epidural hematoma is rare. It is more common in pediatrics than in adults. Although it has been known that these cases are frequently associated with abducens nerve palsy, internal carotid artery stenosis is rarely found with those hematomas.

CASE REPORT

An 8-year-old girl was transferred to our hospital following a traffic accident. She had clear consciousness with right abducens nerve palsy. Computed tomography revealed the left side of both retroclival hematoma without clival fracture and subarachnoid hemorrhage at the Sylvian fissure. She also had a fracture of left femoral neck and ipsilateral lung contusion. Magnetic resonance imaging revealed a retroclival hematoma located in the epidural space and severe stenosis of left internal carotid artery (ICA) from the cavernous to supraclinoid portion without evidence of brain contusion. She was managed conservatively, and her right abducens nerve palsy recovered completely without deterioration of other neurological findings. Neuroradiological findings suggested this ICA stenosis as traumatic dissection. She was discharged home 2 months after the traffic accident.

CONCLUSION

Retroclival epidural hematoma without clival fracture associated with ipsilateral ICA stenosis is extremely rare. Although the exact mechanism of the ICA stenosis remains unclear, cerebral vascular events should be considered in the cases with traumatic retroclival hematoma.