Posttraumatic Carotid Artery Dissection in Children: Not to be missed!

Abstract

PTCAD may result from neck and head trauma. To avoid secondary AIS, radiologists should be familiar with neuroimaging findings in children, especially as acute PTCAD may initially be clinically silent. Consequently, pediatric neuroradiologists should actively exclude PTCAD in children with head and neck trauma.

How do we Handle Traumatic Pediatric Carotid Artery Dissection?

“…If either of these tears is able to reconnect to the true lumen, then a double lumen is created in the blood vessel, thereby causing a threat of thromboembolism as well. On the contrary, in adults; the dissection occurs usually at the bifurcation since atheromatous [6]. In our case, the dissection occurred at the 10 mm distal to the bifurcation, at the middle cervical segment of the internal carotid artery.…”

“…Severe head and neck trauma in pediatric group has been a challenge for physicians if it is associated with CAD [5,6]. In high velocity trauma, especially in paediatric population; upper cervical vertebral fractures with spinal cord injuries associated with severe head trauma can occur.…”

“…Conventional angiography is stated to be the diagnostic goldstandard in diagnosing CAD [3,6]. There are specific angiographic findings in CAD: (1) identification of intimal flaps and double lumen, (2) aneurysmal pouch formation, (3) occlusion often tapering with a flame-shape appearance [13].…”

“…It is stated that the most vulnerable segment of the carotid artery is the most distal cervical segment before entering the carotid canal at the skull base. The mechanism was explained as: the stretching of the artery at the proximal cervical vertebral column with hyperflexion or extension or rotation of the neck causes intimal tears in the artery wall [1,2,6]. Subintimal tear in the arterial wall causes stenosis and thromboembolism; on the other hand, sub adventitial tear causes pseudo aneurysm formation and potential rupture [7].…”

“…However, MR Angiography gives limited information in cases with intracranial dissection and posterior circulation pathologies. Therefore; conventional angiography should be performed for such cases [6].…”