Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy; Master in Pediatrics and Pediatric Subspecialties, University of Padova, Padova, Italy.
Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy; Neuroimmunology group, Paediatric Research Institute "Città della Speranza", Padova, Italy.
Pediatr Neurol. 2023 Feb;139:13-21. doi: 10.1016/j.pediatrneurol.2022.10.008. Epub 2022 Oct 28.
Carotid artery (CA) dissection is a rare etiology of neonatal arterial ischemic stroke (NAIS).
We describe one novel case and conduct a systematic literature review on NAIS attributed to CA dissection, to collect data on its clinical-radiological presentation, treatment, and outcome.
Eight published cases of NAIS attributed to CA dissection were identified and analyzed with our case. All patients (nine of nine) were born at term, and eight of nine experienced instrumental/traumatic delivery or urgent Caesarean section. None had fetal problems during pregnancy or thrombophilia. Signs and symptoms at presentation (between days of life 0 and 6) included seizures (eight of nine), respiratory distress or irregular breathing (five of nine), hyporeactivity, decreased consciousness or irritability (four of nine), and focal neurological signs (two of nine). At magnetic resonance imaging (MRI), stroke was unilateral in seven of nine and extensive in five of nine. CA dissection was documented by neuroimaging or at postmortem studies (seven of nine), and hypothesized by the treating physicians based on delivery and neuroradiology characteristics (in the remaining two of nine). Antithrombotic treatment was used in two of nine. According to available follow-up, one of eight died at age seven days, seven of eight had neurological/epileptic sequelae, and CA recanalization occurred in three of four.
NAIS attributed to CA dissection is rarely identified in the literature, often preceded by traumatic/instrumental delivery, presenting with seizures and systemic signs/symptoms, and often characterized by extensive MRI lesions and neurological sequelae. Definite evidence and recommendations on antithrombotic treatment are lacking.
颈动脉（CA）夹层是新生儿动脉缺血性脑卒中（NAIS）的罕见病因。
我们描述了一个新病例，并对归因于 CA 夹层的 NAIS 进行了系统的文献回顾，以收集其临床-影像学表现、治疗和结果的数据。
确定并分析了 8 例归因于 CA 夹层的 NAIS 病例，包括我们的病例。所有患者（9 例中有 9 例）均足月出生，9 例中有 8 例经历了器械/创伤性分娩或紧急剖宫产。无一例在怀孕期间或存在血栓形成倾向时有胎儿问题。发病时的体征和症状（在出生后 0 至 6 天）包括癫痫发作（9 例中有 8 例）、呼吸窘迫或不规则呼吸（9 例中有 5 例）、反应迟钝、意识减退或烦躁（9 例中有 4 例）和局灶性神经体征（9 例中有 2 例）。在磁共振成像（MRI）中，7 例中风为单侧，5 例广泛。7 例通过神经影像学或尸检研究证实了 CA 夹层，2 例根据分娩和神经放射学特征由治疗医生假设（9 例中有 2 例）。9 例中有 2 例使用了抗血栓治疗。根据现有的随访结果，1 例在 7 天大时死亡，8 例中有 7 例有神经/癫痫后遗症，4 例中有 3 例 CA 再通。
文献中很少发现归因于 CA 夹层的 NAIS，通常在创伤性/器械性分娩之前发生，表现为癫痫发作和全身体征/症状，并且通常具有广泛的 MRI 病变和神经后遗症。缺乏关于抗血栓治疗的明确证据和建议。
