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Dissecting Hematoma of Intracranial Internal Carotid Artery in an 8-year-old Girl

Published online by Cambridge University Press:  02 December 2014

Roy H. Rhodes ,
Susan Phillips ,
Frances A. Booth  and
Kenneth G. Magnus
Roy H. Rhodes
Affiliation:
Department of Pathology, University of Manitoba, Health Sciences Centre, Winnipeg, Manitoba, Canada
Susan Phillips
Affiliation:
Department of Pathology, University of Manitoba, Health Sciences Centre, Winnipeg, Manitoba, Canada
Frances A. Booth
Affiliation:
Department of Pediatrics and Child Health University of Manitoba, Health Sciences Centre, Winnipeg, Manitoba, Canada
Kenneth G. Magnus
Affiliation:
Department of Radiology, University of Manitoba, Health Sciences Centre, Winnipeg, Manitoba, Canada
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Abstract

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Background:

An 8-year-old girl had a minor fall without head trauma and she collapsed the following day while playing. She was awake but mute with focal neurologic signs when admitted to hospital. Radiologic imaging studies showed a progressive left cerebral infarct with left hemisphere vascular narrowing and beading. She died on the third hospital day.

Methods:

Autopsy including exploration of neck vessels and neuropathological examination was performed. Postmortem studies included immunostaining for immunoglobulins and fixed complement.

Results:

Subtotal subintimal dissections of both proximal supraclinoid internal carotid arteries were found microscopically. On the left, the subintimal dissection extended into the major branches of the left internal carotid artery as dissecting hematomas with a major compromise of the arterial lumina. Specific IgM deposition at the dissection sites was found. A literature review shows that subintimal dissection of the intracranial internal carotid artery or its branches occurs rarely, it is often fatal, and it is present in patients with a mean age of 17.5 years in cases studied pathologically. Trauma and physical exertion are the most common associated factors.

Conclusions:

Among the causes of ischemic stroke in young individuals, dissecting hematomas of the intracranial portions of the internal carotid artery system rank low. Few reported cases have identifiable pre-existing pathology. The pathogenesis of dissecting hematomas in this region is reviewed and expanded with speculation regarding relevant developmental, anatomical, flow stress and possibly humoral factors that are involved in the disruption of the arterial elastica and subsequent development and extension of a subintimal hematoma resulting in luminal closure and often death.

Résumé:

RÉSUMÉ:

Hématome disséquant de la carotide interne intracrânienne chez une fillette de 8 ans.

Introduction:

Une fillette âgée de 8 ans a fait une chute mineure sans traumatisme crânien et elle s'est affaissée en jouant le lendemain. Elle était consciente mais ne pouvait parler et présentait des signes neurologiques focaux à l'admission. Des études radiologiques ont montré un infarctus cérébral gauche progressif avec un rétrécissement vascu-laire à l'hémisphère gauche avec aspect en chapelet. Elle est décédée trois jours après son admission à l'hôpital.

Méthodes:

Une autopsie a été pratiquée, incluant une exploration des vaisseaux du cou et un examen neuropathologique incluant des études immunohistochimiques pour les immunoglobulines et la fixation du complément.

Résultats:

À la microscopie, on a constaté la présence de dissection sous-intimale subtotale de la por-tion supraclinoïdienne proximale des carotides internes. À gauche, la dissection sous-intimale s'étendait aux branches majeures de la carotide interne gauche sous forme d'hématomes disséquants qui compromettaient de façon importante la lumière artérielle. Des IgM spécifiques étaient présentes aux sites de dissection. Une revue de la littérature a montré que la dissection sous-intimale de la carotide interne intracrânienne ou de ses branches est rare, souvent fatale, et se retrouve chez des patients dont l'âge moyen est 17.5 ans dans les cas ayant subi un examen anatomopathologique. Un traumatisme ou l'activité physique intense sont les facteurs les plus souvent associés.

Conclusions:

Parmi les causes d'accident vasculaire cérébral chez les jeunes, l'hématome disséquant de la portion intracrânienne du système carotidien interne est une cause peu fréquente. Parmi les cas rapportés, peu ont une pathologie préexistante identifiable. Nous revoyons la pathogénèse des hématomes disséquants de cette région et nous discutons de facteurs du développement, de l'anatomie, des forces de cisaillement et de facteurs humoraux potentiels qui sont impliqués dans la perturbation de la couche élas-tique artérielle, et le développement subséquent et l'extension d'un hématome sous-intimal menant à l'oblitération luminale et souvent au décès.

Type
Case Report
Information
Canadian Journal of Neurological Sciences , Volume 28 , Issue 4 , November 2001 , pp. 357 - 364
Copyright
Copyright © The Canadian Journal of Neurological 2001

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