Child's Nervous System

, 27:1169 | Cite as

Posttraumatic cerebral infarction due to progressive occlusion of the internal carotid artery after minor head injury in childhood: a case report

Case Report
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Accepted:

Abstract

Purpose

Although minor head injury in childhood is a common occurrence and usually no complications, posttraumatic cerebral infarction has rarely been reported. Such infarction is characterized by occlusion of the lateral lenticulostriate artery. The authors report an atypical case of posttraumatic occlusion of the internal carotid artery (ICA) after minor head injury in childhood.

Case report

A healthy 16-year-old boy was hit on the head by a pitch while playing baseball. He developed a transient ischemic attack involving the left extremities 15 min after the accident. Initial magnetic resonance imaging revealed neither hemorrhage nor infarction, and MR angiography demonstrated mild stenosis of the right carotid fork. Conservative therapy was started. However, 24 h after the accident, he suddenly developed left hemiparesis. Emergent neuroimaging demonstrated progressive occlusion of the supraclinoid portion of the right ICA and cerebral infarction of the deep white matter in the right frontal lobe. The hemiparesis deteriorated and the infarction area continued to expand on a daily. The patient underwent emergent superficial temporally artery-middle cerebral artery (STA-MCA) bypass. Intraoperative observation demonstrated that the supraclinoid portion of the right ICA was not thrombosed but pale with low tension and did not appear dissected. He fully recovered by 2 weeks after the operation. Postoperative investigations showed gradual improvement of the ICA occlusion.

Discussion

Minor head injury can cause cerebral infarction in childhood, although this is rare. If conservative therapy cannot prevent progressive cerebral infarction, STA-MCA bypass should be considered in case of the ICA occlusion.

Keywords

Bypass Cerebral infarction Childhood Internal carotid artery Minor head injury 
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References

  1. 1.
    Adams C, Trevenen C (1996) Middle cerebral artery dissection. Neuropediatrics 27:331–332PubMedCrossRefGoogle Scholar
  2. 2.
    Ahn JY, Han IB, Chung YS, Yoon PH, Kim SH (2006) Posttraumatic infarction in the territory supplied by the lateral lenticulostriate artery after minor head injury. Childs Nerv Syst 22:1493–1496PubMedCrossRefGoogle Scholar
  3. 3.
    Ajir F, Tibbetts JC (1981) Post-traumatic occlusion of the supraclinoid internal carotid artery. Neurosurgery 9:173–176PubMedCrossRefGoogle Scholar
  4. 4.
    Binning MJ, Khalessi AA, Siddiqui AH, Hopkins LN, Levy EI (2010) Stent placement for the treatment of a symptomatic intracranial arterial dissection in an adolescent. J Neurosurg Pediatr 6:154–158PubMedCrossRefGoogle Scholar
  5. 5.
    Dharker SR, Mittal RS, Bhargava N (1993) Ischemic lesions in basal ganglia in children after minor head injury. Neurosurgery 33:863–865PubMedCrossRefGoogle Scholar
  6. 6.
    Erbayraktar S, Tekinsoy B, Acar F, Acar U (2001) Posttraumatic isolated infarction in the territory of Heubner’s and lenticulostriate arteries: case report. Kobe J Med Sci 47:113–121PubMedGoogle Scholar
  7. 7.
    Jackson CL, Reidy MA (1993) Basic fibroblast growth factor: its role in the control of smooth muscle cell migration. Am J Pathol 143:1024–1031PubMedGoogle Scholar
  8. 8.
    Jawien A, Bowen-Pope DF, Lindner V, Schwartz SM, Clowes AW (1992) Platelet-derived growth factor promotes smooth muscle migration and intimal thickening in a rat model of balloon angioplasty. J Clin Invest 89:507–511PubMedCrossRefGoogle Scholar
  9. 9.
    Jeon P, Kim BM, Kim DI, Shin YS, Kim KH, Park SI, Kim DJ, Suh SH (2010) Emergent self-expanding stent placement for acute intracranial or extracranial internal carotid artery dissection with significant hemodynamic insufficiency. AJNR Am J Neuroradiol 31:1529–1532PubMedCrossRefGoogle Scholar
  10. 10.
    Kappelle LJ, Willemse J, Ramos LM, van Gijn J (1982) Ischaemic stroke in the basal ganglia and internal capsule in childhood. Brain Dev 11:283–292Google Scholar
  11. 11.
    Kieslich M, Fiedler A, Heller C, Kreuz W, Jacobi G (2002) Minor head injury as cause and co-factor in the aetiology of stroke in childhood: a report of eight cases. J Neurol Neurosurg Psychiatry 73:13–16PubMedCrossRefGoogle Scholar
  12. 12.
    Maki Y, Akimoto H, Enomoto T (1980) Injuries of basal ganglia following head trauma in children. Childs Brain 7:113–123PubMedGoogle Scholar
  13. 13.
    Matsumoto H, Kohno K (2009) Indications for one-stage extensive indirect vascular reconstructive surgery for pediatric moyamoya disease: 4 case reports. Surg Neurol 72:538–544PubMedCrossRefGoogle Scholar
  14. 14.
    Miyata M, Yamasaki S, Hirayama A, Tamaki N (1994) Traumatic middle cerebral artery occlusion. No Shinkei Geka 22:253–257PubMedGoogle Scholar
  15. 15.
    Muthukumar N (1996) Basal ganglia–internal capsule low density lesions in children with mild head injury. Br J Neurosurg 10:391–393PubMedCrossRefGoogle Scholar
  16. 16.
    Nabika S, Kiya K, Satoh H, Mizoue T, Oshita J, Kondo H (2007) Ischemia of the internal capsule due to mild head injury in a child. Pediatr Neurosurg 43:312–315PubMedCrossRefGoogle Scholar
  17. 17.
    Nakashima S, Tomokiyo M, Koga H, Furukawa Y, Nomura S, Shimokawa S, Nakagawa S, Anegawa S, Hayashi T (2001) Intracranial occlusion of the internal carotid artery after minor closed head injury. No To Shinkei 53:975–978PubMedGoogle Scholar
  18. 18.
    Nussbaum ES, Janjua TM, Defillo A, Lowary JL, Nussbaum LA (2010) Emergency extracranial–intracranial bypass surgery for acute ischemic stroke. J Neurosurg 112:666–673PubMedCrossRefGoogle Scholar
  19. 19.
    O'Brien NF, Reuter-Rice KE, Khanna S, Peterson BM, Quinto KB (2010) Vasospasm in children with traumatic brain injury. Intensive Care Med 36:680–687PubMedCrossRefGoogle Scholar
  20. 20.
    Oertel M, Boscardin WJ, Obrist WD, Glenn TC, McArthur DL, Gravori T, Lee JH, Martin NA (2005) Posttraumatic vasospasm: the epidemiology, severity, and time course of an underestimated phenomenon: a prospective study performed in 299 patients. J Neurosurg 103:812–824PubMedCrossRefGoogle Scholar
  21. 21.
    Oka F, Shimizu H, Matsumoto Y, Watanabe M, Tominaga T (2008) Ischemic stroke due to dissection of intracranial internal carotid artery: implications for early surgical treatment. Surg Neurol 69:578–584, discussion 584–585PubMedCrossRefGoogle Scholar
  22. 22.
    Okuno T, Takao T, Ito M, Konishi Y, Mikawa H, Nakano Y (1980) Infarction of the internal capsule in children. J Comput Assist Tomogr 4:770–774PubMedCrossRefGoogle Scholar
  23. 23.
    Rana KS, Behera MK, Adhikari KM (2006) Ischemic stroke following mild head injury is it the cause. Indian Pediatr 43:994–997PubMedGoogle Scholar
  24. 24.
    Rutherfoord GS, Dada MA, Nel JP (1996) Cerebral infarction and intracranial arterial dissection in closed head injury. Am J Forensic Med Pathol 17:53–57PubMedCrossRefGoogle Scholar
  25. 25.
    Sebire G (2006) Transient cerebral arteriopathy in childhood. Lancet 368:8–10PubMedCrossRefGoogle Scholar
  26. 26.
    Seckin H, Demirci AY, Degerliyurt A, Dagli M, Bavbek M (2008) Posttraumatic infarction in the basal ganglia after a minor head injury in a child: case report. Turk Neurosurg 18:415–419PubMedGoogle Scholar
  27. 27.
    Shaffer L, Rich PM, Pohl KR, Ganesan V (2003) Can mild head injury cause ischaemic stroke? Arch Dis Child 88:267–269PubMedCrossRefGoogle Scholar
  28. 28.
    Sherman P, Oka M, Aldrich E, Jordan L, Gailloud P (2006) Isolated posterior cerebral artery dissection: report of three cases. AJNR Am J Neuroradiol 27:648–652PubMedGoogle Scholar
  29. 29.
    Yoshida S, Yamamoto T, Oda Y, Kawakami Y, Ban S, Sato S, Matsumoto S, Nakazawa K (1996) A pediatric case of cerebral infarction following minor head injury presenting interesting neuroradiological findings. No Shinkei Geka 24:347–350PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  1. 1.Department of NeurosurgeryEhime Prefectural Central HospitalEhimeJapan

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