Neonatal Arterial Ischemic Stroke Secondary to Carotid Artery Dissection: A Case Report and Systematic Literature Review

Baggio, Laura; Nosadini, Margherita; Pelizza, Maria Federica; Pin, Jacopo Norberto; Zarpellon, Anna; Tona, Clarissa; Perilongo, Giorgio; Simioni, Paolo; Toldo, Irene; Talenti, Giacomo; Sartori, Stefano

doi:10.1016/j.pediatrneurol.2022.10.008

Cited by 4 publications

(7 citation statements)

References 29 publications

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“…Hence, the MRAs and vessel-wall MRIs done quite late in the disease course of our patients could not demonstrate the typical angiographic signs of dissection and the localized eccentric contrast enhancement and perivascular edema that are characteristic of arterial dissections. 19 Rather, the pattern of generalized vessel wall inflammation reflected the inflammation of multiple vessels, although angiographic abnormalities were not discernible in all of them. The systemic vascular response to the liberated cytokines leads to vessel wall inflammation and directly alters the shape of the vessel walls, which leads to strokes.…”

Section: Discussionmentioning

confidence: 94%

“…All the patients had fever as the first symptom of their disease onset. The median (interquartile range) time gaps between the onset of fever and the occurrences of the neurodeficits were 9 (7-10.5) days following the initial acute ischemic stroke and 19 (17)(18)(19)(20)(21)(22) days following the recurrence of acute ischemic stroke. The MRI and MRA brain were done at median durations of 8 (6.5-9.4) days and 14 (12.9-16.7) days after admission.…”

Section: Resultsmentioning

confidence: 99%

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The Spectrum of Pediatric Infection-Associated Intracranial Arteriopathies and Acute Ischemic Stroke at 2 Eastern Indian Tertiary Care Centres

et al. 2023

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Introduction Major and minor pediatric infections may cause intracranial arteriopathies, the long-term outcome of which we investigated and identified the factors influencing the progression/resolution of arteriopathies. Methods We collected the clinical and radiological data of children aged 1 month–15 years who had ischemic stroke with definite arteriopathy following a recent febrile infection. Repeated neuroimaging was done over the next year to ascertain recurrent strokes and the progression and resolution of arteriopathies. Results The anterior circulation was more frequently affected (83.33%), predominantly involving the middle cerebral artery (41.67%), resolving in 20.84% of cases and progressing in 33.33% of cases. Lesions were commonly unilateral (54.17%) and stenotic (75%), resulting predominantly in cortical infarcts (45.83%), with hemiparesis being the most common neurodeficiency. Apart from tubercular meningitis patients, others had a good functional outcome. Conclusion Lower age, minor infections, and unilateral arteriopathies had a significantly higher chance of resolution. Postviral arteriopathies had a significantly lower chance of progression compared with those following bacterial infections. Progressive and bilateral arteriopathies were significantly associated with worse outcomes and recurrent strokes.

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Section: Discussionmentioning

confidence: 94%

Section: Resultsmentioning

confidence: 99%

The Spectrum of Pediatric Infection-Associated Intracranial Arteriopathies and Acute Ischemic Stroke at 2 Eastern Indian Tertiary Care Centres

et al. 2023

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“…20 Neither hemorrhagic nor ischemic stroke should logically be influenced by mechanical forces to the head based on their proposed mechanisms; however, the connection in the literature is tenaciously persistent. 21,22 A proposed mechanism of idiopathic hemorrhagic stroke is congenital blood vessel abnormalities ruptured by the hemodynamic challenges of delivery, a hypothesis supported by very low recurrence rates. 16 The proposed mechanism for perinatal arterial ischemic stroke is placental thromboembolism and/or vasculopathy.…”

Section: Discussionmentioning

confidence: 99%

“…By contrast, there is a dearth of evidence for alternative traumatic mechanisms leading to stroke, such as arterial dissection, despite thousands of cases with vascular imaging now in the literature. 22 In addition, previous studies have been hampered by the use of administrative data that build into the coding the idea that the process of birth is the cause of injury, such as ICD codes P11.0 “cerebral edema due to birth injury” or P11.2 “unspecified brain damage due to birth injury,” or using the presence of neonatal seizure to indicate “birth trauma.” 26 The implication that an injury has been inflicted on a neonate by the efforts to expedite delivery to save its life disregards the underlying pathology for which the lifesaving intervention was needed in the first place. Such an erroneous conclusion can have far reaching implications in obstetrical practice and parent mental health.…”

Section: Discussionmentioning

confidence: 99%

Relationship Between Neonatal Brain Injury and Objective Measures of Head Trauma

Dunbar,

Norris,

Craig

et al. 2023

Neurology

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Background and objectives:Neonatal brain injury is a common and devastating diagnosis conferring lifelong challenges for children and families. The role of mechanical forces applied to the head, often referred to as “birth trauma”, are often considered though evidence for this association is lacking. The objective of this study was to investigate the association between common types of neonatal brain injury and scalp swelling using a novel method to quantify scalp swelling as an unbiased proxy for mechanical forces applied to the head.Methods:Case-control study using population-based, prospectively collected tertiary care center databases and healthy controls from the Human Connectome Development Project. Inclusion: infants born 32-42 weeks gestational age and MRI in the first 9 days. Outcomes: healthy neonates, hypoxic ischemic encephalopathy (HIE) with or without brain injury, or stroke (ischemic or hemorrhagic). Volume of scalp swelling was objectively quantified by a novel imaging method blinded to brain injury. Variables included mode of delivery and use of instrumentation. Statistical tests: Kruskal-Wallis test, chi square, multivariable and multinomial logistic regression.Results:There were 309 infants included (55% male): 72 healthy controls, 77 HIE without brain injury on MRI, 78 HIE with brain injury, and 82 with stroke (60 ischemic, 22 hemorrhagic). Scalp swelling was present in 126 (40.8%, 95% CI 35.2-46.5%) with no difference in proportions between outcome groups. Median volume was lower in healthy controls (2.4mL, IQR 1.1-5.6) than those with HIE with brain injury (RRR 1.1, 95% CI 1.05-1.2), HIE without brain injury (RRR 1.1, 95% CI 1.06-1.2) and hemorrhagic stroke (RRR 1.1, 95% CI 1.05-1.2), but not ischemic stroke (RRR 1.1, 95% CI 0.99-1.2). Scalp swelling was associated with instrumented delivery (OR 2.1, 95% CI 1.0-4.1), but not associated with increased odds of brain injury in those with HIE (OR 1.5, 95% CI 0.76-3.30). Scalp swelling measures were highly reliable (ICC=0.97).Discussion:“Birth trauma” quantified by scalp swelling volume was more common in infants with difficult deliveries but not associated with greater odds of brain injury due to hypoxia or stroke. These results may help parents and practitioners to dissociate the appearance of trauma with the risk of brain injury.

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“…The presence of shoulder dystocia during delivery may cause traction on the carotid vessels, particularly during the process of head and shoulder delivery [15]. Furthermore, vasospasm due to compression, especially in the context of forceps-assisted delivery, could also play a role in carotid artery dissection [18].…”

Section: Discussionmentioning

confidence: 99%

Contralateral Massive Neonatal Arterial Ischemic Stroke Secondary to Carotid Artery Dissection: A Case Report

Elgendy,

Cortez

2023

Cureus

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Carotid artery dissection is an infrequent cause of neonatal-perinatal stroke. Its rarity may be due to underdiagnosis or lack of awareness. We report a case of a full-term, large-for-gestational-age (LGA) male infant delivered at 39 weeks gestation. Pertinent prenatal and perinatal history include gestational diabetes, preeclampsia, and the use of forceps to assist in delivery due to shoulder dystocia. The infant presented with apnea and cyanosis while rooming which prompted admission to the neonatal intensive care unit (NICU). Initial sonographic investigation revealed an infarct, subsequently confirmed as a massive left-sided infarct by magnetic resonance imaging (MRI) of the brain. Further, computerized tomography (CT) angiography confirmed a dissection in the right common and internal carotid arteries. The child was treated with antiepileptic and antithrombotic medications. He is now undergoing regular neurodevelopmental monitoring and rehabilitation. As per our sources, this case is the first to report a contralateral significant perinatal stroke due to carotid artery dissection. It underscores the importance of recognizing subtle signs of neonatal encephalopathy that may be due to perinatal stroke, of which carotid artery dissection is an uncommon etiology. Assisted delivery techniques such as the use of forceps may be risk factors.

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Neonatal Arterial Ischemic Stroke Secondary to Carotid Artery Dissection: A Case Report and Systematic Literature Review

Cited by 4 publications

References 29 publications

The Spectrum of Pediatric Infection-Associated Intracranial Arteriopathies and Acute Ischemic Stroke at 2 Eastern Indian Tertiary Care Centres

The Spectrum of Pediatric Infection-Associated Intracranial Arteriopathies and Acute Ischemic Stroke at 2 Eastern Indian Tertiary Care Centres

Relationship Between Neonatal Brain Injury and Objective Measures of Head Trauma

Contralateral Massive Neonatal Arterial Ischemic Stroke Secondary to Carotid Artery Dissection: A Case Report

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