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