Elgendy Marwa M, Cortez Josef
Neonatology, University of Florida College of Medicine - Jacksonville, Jacksonville, USA.
Cureus. 2023 Nov 7;15(11):e48452. doi: 10.7759/cureus.48452. eCollection 2023 Nov.
Carotid artery dissection is an infrequent cause of neonatal-perinatal stroke. Its rarity may be due to underdiagnosis or lack of awareness. We report a case of a full-term, large-for-gestational-age (LGA) male infant delivered at 39 weeks gestation. Pertinent prenatal and perinatal history include gestational diabetes, preeclampsia, and the use of forceps to assist in delivery due to shoulder dystocia. The infant presented with apnea and cyanosis while rooming which prompted admission to the neonatal intensive care unit (NICU). Initial sonographic investigation revealed an infarct, subsequently confirmed as a massive left-sided infarct by magnetic resonance imaging (MRI) of the brain. Further, computerized tomography (CT) angiography confirmed a dissection in the right common and internal carotid arteries. The child was treated with antiepileptic and antithrombotic medications. He is now undergoing regular neurodevelopmental monitoring and rehabilitation. As per our sources, this case is the first to report a contralateral significant perinatal stroke due to carotid artery dissection. It underscores the importance of recognizing subtle signs of neonatal encephalopathy that may be due to perinatal stroke, of which carotid artery dissection is an uncommon etiology. Assisted delivery techniques such as the use of forceps may be risk factors.
颈动脉夹层是新生儿 - 围产期卒中的罕见病因。其罕见性可能是由于诊断不足或认识不足。我们报告一例孕39周出生的足月、大于胎龄（LGA）男婴。相关的产前和围产期病史包括妊娠期糖尿病、先兆子痫以及因肩难产使用产钳助产。婴儿在母婴同室时出现呼吸暂停和青紫，遂入住新生儿重症监护病房（NICU）。最初的超声检查发现梗死灶，随后经脑部磁共振成像（MRI）证实为左侧大面积梗死。此外，计算机断层扫描（CT）血管造影证实右侧颈总动脉和颈内动脉夹层。患儿接受了抗癫痫和抗血栓药物治疗。他目前正在接受定期的神经发育监测和康复治疗。据我们所知，该病例是首例报告因颈动脉夹层导致对侧严重围产期卒中的病例。它强调了识别可能由围产期卒中引起的新生儿脑病细微体征的重要性，其中颈动脉夹层是一种不常见的病因。诸如使用产钳等助产技术可能是危险因素。
