Perinatal arterial ischemic stroke related to carotid artery occlusion

Joel Fluss, Stephanie Garcia-Tarodo, Michèle Granier, Frédéric Villega, Solène Ferey, Béatrice Husson, Manoelle Kossorotoff, Vincent Muehlethaler, Sebastien Lebon, Stéphane Chabrier
European Journal of Paediatric Neurology. 2016-07-01; 20(4): 639-648
DOI: 10.1016/J.EJPN.2016.03.003

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Fluss J(1), Garcia-Tarodo S(2), Granier M(3), Villega F(4), Ferey S(5), Husson
B(6), Kossorotoff M(7), Muehlethaler V(8), Lebon S(9), Chabrier S(10).

Author information:
(1)Pediatric Neurology Unit, Pediatric Subspecialities Service, Children’s
Hospital, Geneva University Hospitals, Switzerland. Electronic address:
.
(2)Pediatric Neurology Unit, Pediatric Subspecialities Service, Children’s
Hospital, Geneva University Hospitals, Switzerland.
(3)Neonatal Unit, Sud-Francilien Hospital Centre, Corbeil, France.
(4)Pediatric Neurology, Children’s Hospital, Bordeaux University Hospital,
Bordeaux, France.
(5)Unit of Pediatric Radiology, Children’s Hospital, Geneva University
Hospitals, Switzerland.
(6)French Centre for Pediatric Stroke and Pediatric Radiology, Bicêtre
University Hospital Centre, Le Kremlin-Bicêtre, France.
(7)French Centre for Pediatric Stroke, Pediatric Neurology Department,
APHP-Necker-Enfants Malades, University Hospital, Paris, France.
(8)Neonatal Unit, Department of Pediatrics, Lausanne University Hospital,
Lausanne, Switzerland.
(9)Pediatric Neurology Unit, Department of Pediatrics, Lausanne University
Hospital, Switzerland.
(10)French Centre for Pediatric Stroke, University Hospital Centre of
Saint-Etienne, 42055 Saint-Etienne Cedex 2, France.

Comment in
Eur J Paediatr Neurol. 2017 Jul;21(4):687-688.
Eur J Paediatr Neurol. 2017 Jul;21(4):689-690.

BACKGROUND: The aetiology of perinatal arterial ischemic stroke remains
speculative. It is however widely accepted that the aetiology is multifactorial,
involving various maternal, placental, foetal and neonatal risk factors. A
resulting thromboembolic process is hypothesized and the placenta identified as
the most plausible source. An arteriopathy, as observed in a significant
proportion of childhood ischemic stroke, is thought to be rare.
METHODS: We report here five cases of perinatal stroke that differ from the vast
majority by documented carotid occlusion, and add eleven other similar cases
from the literature.
RESULTS: In the majority, an intraluminal thrombus of placental origin is the
most probable hypothesis, while in the remaining ones, one can reasonably
presume a direct vessel wall injury related to a traumatic delivery, yet
generally unproven by imaging.
CONCLUSION: We hypothesize that most of these cases share similar
pathophysiology with the more common perinatal arterial ischemic stroke but
differ by a persistent identified thrombus in the carotid artery at the time of
first imaging, leading to a more severe and extended ischemic damage responsible
for an adverse neurological outcome.