Matsumoto Hiroaki, Kohno Kanehisa
Department of Neurosurgery, Ehime Prefectural Central Hospital, Ehime, 790-0024, Japan.
Childs Nerv Syst. 2011 Jul;27(7):1169-75. doi: 10.1007/s00381-011-1426-9. Epub 2011 Mar 23.
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.
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.
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.
尽管儿童轻度头部损伤很常见且通常无并发症，但创伤后脑梗死鲜有报道。此类梗死以外侧豆纹动脉闭塞为特征。作者报告了一例儿童轻度头部损伤后颈内动脉（ICA）创伤后闭塞的非典型病例。
一名健康的16岁男孩在打棒球时头部被投球击中。事故发生15分钟后，他出现了涉及左上肢的短暂性脑缺血发作。最初的磁共振成像未显示出血或梗死，磁共振血管造影显示右侧颈动脉分叉处轻度狭窄。开始进行保守治疗。然而，事故发生24小时后，他突然出现左侧偏瘫。紧急神经影像学检查显示右侧ICA鞍上部分逐渐闭塞，右侧额叶深部白质脑梗死。偏瘫加重，梗死面积每日持续扩大。患者接受了紧急颞浅动脉-大脑中动脉（STA-MCA）搭桥手术。术中观察发现右侧ICA鞍上部分未形成血栓，但颜色苍白、张力低，且未出现夹层。术后2周他完全康复。术后检查显示ICA闭塞逐渐改善。
儿童轻度头部损伤虽罕见，但可导致脑梗死。如果保守治疗无法预防进行性脑梗死，在ICA闭塞的情况下应考虑STA-MCA搭桥手术。
