Orman Gunes, Tekes Aylin, Poretti Andrea, Robertson Courtney, Huisman Thierry A G M
Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD.
J Neuroimaging. 2014 Sep-Oct;24(5):467-72. doi: 10.1111/jon.12071. Epub 2013 Nov 19.
Post-traumatic carotid artery dissection (PTCAD) may result in acute arterial ischemic stroke (AIS). Pediatric PTCAD is rarely diagnosed prior to onset of neurological symptoms. We report on neuroimaging findings in a series of children with PTCAD.
Five children with head or neck trauma were included in this study. Clinical histories were reviewed for mechanism of trauma, symptoms, complications, therapy, and outcome. Computed tomography (CT), magnetic resonance imaging (MRI), and CT/MR angiography (CTA, MRA) studies were retrospectively evaluated for signs and complications of PTCAD and presence and extent of skull base fractures.
PTCAD was located at the level of the skull base in all children and was associated with a skull base fracture in two. The diagnosis was made in five children by combined MRI/MRA and in two by CTA. Air in the carotid canal suggested skull base injury with PTCAD in two children. PTCAD was complicated by AIS in three children.
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.
创伤后颈动脉夹层（PTCAD）可能导致急性动脉缺血性卒中（AIS）。小儿PTCAD在神经症状发作前很少被诊断出来。我们报告了一系列小儿PTCAD的神经影像学表现。
本研究纳入了5名头部或颈部外伤的儿童。回顾临床病史，了解创伤机制、症状、并发症、治疗及预后情况。对计算机断层扫描（CT）、磁共振成像（MRI）以及CT/MR血管造影（CTA、MRA）检查结果进行回顾性评估，以了解PTCAD的体征和并发症以及颅底骨折的存在情况和范围。
所有儿童的PTCAD均位于颅底水平，其中2例与颅底骨折相关。5例儿童通过MRI/MRA联合诊断，2例通过CTA诊断。2例儿童的颈动脉管内有气体提示伴有PTCAD的颅底损伤。3例儿童的PTCAD并发AIS。
PTCAD可能由颈部和头部创伤引起。为避免继发性AIS，放射科医生应熟悉小儿的神经影像学表现，尤其是急性PTCAD最初可能在临床上无明显症状。因此，小儿神经放射科医生应积极排除头部和颈部外伤儿童的PTCAD。
