Key result
Carotid artery dissection following assisted delivery is linked to massive contralateral neonatal ischemic stroke.
Why the study?
Carotid artery dissection is an infrequent cause of neonatal-perinatal stroke, potentially due to underdiagnosis or lack of awareness.
Case Report (n=1)
No
This case highlights that traumatic carotid artery dissection from assisted delivery can cause contralateral massive neonatal arterial ischemic stroke, emphasizing the need for early imaging and consideration of anticoagulation.
Alerts clinicians to rare assisted-delivery carotid dissection in neonatal stroke; hypothesis-generating case report leaves confirmation to larger studies.
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.
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Elgendy et al. (2023) conducted a case report in Neonatal Arterial Ischemic Stroke (n=1). Carotid artery dissection was evaluated on Contralateral massive neonatal arterial ischemic stroke. Carotid artery dissection, potentially related to assisted delivery techniques, can cause contralateral massive neonatal arterial ischemic stroke, underscoring the need to evaluate for this rare etiology in neonates with encephalopathy.
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