A female toddler with severe head trauma was admitted to the pediatric intensive care unit after being run over. Upon admission, she presented with a Glasgow Coma Scale score of 7, right-sided cervical edema, and left-sided hemiparesis. Following evaluation with a full-body CT scan, which revealed a linear fracture in the occipital bone and venous thrombosis, an intracranial pressure sensor was implanted. Due to deteriorating conditions, a transcranial Doppler (TCD) ultrasound was conducted, indicating unilateral ischemia and intracranial hypertension, raising suspicions of internal carotid artery dissection. Magnetic resonance imaging later confirmed the dissection, along with associated cerebral and medullary damage, and the extent of thrombosis.
Internal carotid artery dissection, whether traumatic or spontaneous, is a significant cause of acute ischemic stroke in children. Early detection plays a crucial role in initiating timely treatment. The article highlights the limited evidence regarding the use of TCD for diagnosing internal carotid artery dissection in children. An asymmetry in flow velocities between the middle cerebral arteries and a decrease in pulsatility index on TCD can alert healthcare providers to the possibility of this condition, prompting urgent CT angiography. Bedside TCD sonography offers a sensitive and noninvasive monitoring option to raise clinical suspicion and for ongoing assessment.
Following the confirmation of internal carotid artery dissection, the patient underwent endovascular/reperfusion therapy exclusion and a decompressive craniectomy due to the extent of infarction, cerebral edema, and signs of intracranial hypertension. Subsequent follow-up assessments, including CT angiography at 48 hours and TCD at 96 hours, showed improvement in blood flow, leading to the initiation of antiplatelet medication followed by anticoagulation therapy.
The article references studies that emphasize the importance of tools like TCD in diagnosing conditions like cervical steno-occlusive arteriopathy in infants and traumatic internal carotid artery dissection in head-injured patients. These studies underscore the value of TCD as a useful diagnostic tool in critical care settings, aiding in the timely identification and management of potentially life-threatening conditions.
In conclusion, the case study presented in the article sheds light on the role of transcranial Doppler in diagnosing and monitoring internal carotid artery dissection in pediatric patients, underscoring the significance of early detection and intervention in improving patient outcomes in such critical scenarios.
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