Articles

Post-traumatic cerebral infarction associated with a depressed skull fracture in children: a case report

Muhammad Azhary Lazuardy , Agung Budi Sutiono, Ahmad Adam, Muhammad Zafrullah Arifin

Muhammad Azhary Lazuardy
Resident of Neurosurgery, Department of Neurosurgery, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin Hospital, Bandung, Indonesia. Email: azharylazuardy@gmail.com

Agung Budi Sutiono
Consultant Neurosurgeon, Department of Neurosurgery, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin Hospital, Bandung, Indonesia

Ahmad Adam
Consultant Neurosurgeon, Department of Neurosurgery, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin Hospital, Bandung, Indonesia

Muhammad Zafrullah Arifin
Consultant Neurosurgeon, Department of Neurosurgery, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin Hospital, Bandung, Indonesia
Online First: December 01, 2019 | Cite this Article
Lazuardy, M., Budi Sutiono, A., Adam, A., Arifin, M. 2019. Post-traumatic cerebral infarction associated with a depressed skull fracture in children: a case report. Indonesian Journal of Neurosurgery 2(3). DOI:10.15562/ijn.v2i3.54


Introduction: Post-traumatic cerebral infarction (PTCI) is one of the most severe yet very rare complications after traumatic brain injury in children. Various mechanisms have been suggested, including direct vascular compression, dissection, embolization, cerebral vasospasm, vascular injury, and systemic hypoperfusion. PTCI secondary to direct vascular injury by a skull fracture in children has never been reported, although it is mechanically possible. We reported a case of PTCI secondary to direct vascular injury by a skull fracture in a child.

Case presentation: A 5-years old boy had decreased consciousness and left-sided hemiplegia on admission after experiencing a motor vehicle accident. On examination, he had a GCS score of 11, left-sided hemiplegia, and lacerated wound on his right temporoparietal region with no exposed bone. Head CT scan revealed closed depressed fracture on the right temporoparietal with a large cerebral infarction below the fracture segment. Emergency craniotomy and duramater repair were performed. Improved consciousness was achieved two days after the operation; however, the hemiplegia did not improve. Digital Subtraction Angiography (DSA) after surgery showed disruption of the M3 segment of the right middle cerebral artery. The patient was consulted to do routine physiotherapy. At five months follow up, he came with an improvement in motor strength on his left extremities.

Conclusion: PTCI secondary to direct vascular injury by a skull fracture is very rare in children, but still mechanically possible. Head CT scan and DSA is beneficial for a proper diagnosis. Physiotherapy is vital in children with PTCI due to brain neuroplasticity capabilities that differ from adults.

Keywords: post-traumatic cerebral infarction, pediatric head injury, skull fracture

References

Bae D-H, Choi K-S, Yi H-J, Chun H-J, Ko Y, Bak KH. Cerebral infarction after traumatic brain injury: incidence and risk factors. Korean J Neurotrauma. 2014;10(2): 35 – 40. DOI: 10.13004/kjnt.2014.10.2.35.

Ham H-Y, Lee J-K, Jang J-W, Seo B-R, Kim J-H, Choi J-W. Post-traumatic cerebral infarction: outcome after decompressive hemicraniectomy for the treatment of traumatic brain injury. J Korean Neurosurg Soc. 2011; 50(4): 370 – 6. DOI: 10.3340/jkns.2011.50.4.370.

Yilmaz S, Pekdemir M, Sarisoy HT, Yaka E. Post-traumatic cerebral infarction: a rare complication in a pediatric patient after mild head injury. Ulus Travma Acil Cerrahi Derg. 2011; 17(2): 186 – 8. DOI: 10.5505/tjtes.2011.96658.

Salih MA, Abdel-Gader AG, Al-Jarallah AA, Kentab AY, Alorainy IA, Hassan HH, et al. Stroke in Saudi children. Epidemiology, clinical features and risk factors. Saudi Med J. 2006; 27 Suppl 1: S12 – 20.

Mobbs RJ, Chandran KN. Traumatic middle cerebral artery occlusion: case report and review of pathogenesis. Neurol India. 2001; 49(2): 158 – 61.

Nomura M, Tamase A, Kamide T, Mori K, Seki S, et al. Post-ischaemic hyperperfusion in traumatic middle cerebral artery dissection detected by arterial spin labelling of magnetic resonance imaging. Neuroradiol J. 2016; 29(5): 350 – 5. DOI: 10.1177/1971400916665370.

Loar CR, Chadduck WM, Nugent GR. Traumatic occlusion of the middle cerebral artery. Case report. J Neurosurg. 1973; 39(6): 753 – 6. DOI: 10.3171/jns.1973.39.6.0753.

Kornfeld S, Rodríguez JAD, Everts R, Kaelin-Lang A, Wiest R, Weisstanner C, et al. Cortical reorganisation of cerebral networks after childhood stroke: impact on outcome. BMC Neurol. 2015; 15: 90. DOI: 10.1186%2Fs12883-015-0309-1.

Kim SW, Lee SM, Shin H. Acute cerebral infarction after head injury. J Korean Neurosurg Soc. 2005; 38: 393 – 5.

Meaney DF, Cullen DK. Biomechanical basis of traumatic brain injury. In: Winn HR. (eds.) Youmans & Winn Neurological Surgery. Vol. 4. Philadelphia: Elsevier; 2017. p. 2755 – 64.

Baehr M, Frotscher M. Duus' Topical Diagnosis in Neurology: Anatomy, Physiology, Signs, Symptoms. 4th ed. Stuttgart: Thieme; 2005.


No Supplementary Material available for this article.
Article Views      : 172
PDF Downloads : 87