Internal Carotid Occlusion in a Newborn

The vascular laboratory was called to the neonatal intensive care unit to perform a carotid duplex examination on a 2-day-old infant. This term female newborn was delivered via caesarian because of labor that failed to progress. There were no significant maternal risk factors. On day 2, the infant was noted to have seizures. Magnetic resonance imaging of the brain demonstrated a large left hemispheric infarct with a midline shift. The findings of an echocardiogram were normal. The carotid system was evaluated by the use of a “hockey stick” 15–7 MHz linear array transducer. The common, external, and internal carotid arteries were well visualized bilaterally, as well as the vertebral and subclavian arteries. The right side was normal. The left common carotid artery signal was high resistance and a drumbeat, high resistance signal was noted at the origin of the internal carotid artery. The internal carotid artery appeared to be filled with soft echoes, and no signal was detected within the internal carotid artery beyond the origin. The infant was then transferred to Children's hospital for further evaluation and possible tissue plasminogen activator treatment. Neonatal cerebral infarction has been reported to be present in 1 in 4,000 full-term infants. Neonatal cerebral infarct was found in 12% of infants who developed neonatal seizures. Newborns with arterial ischemic stroke usually present with seizures. Primary risk factors for arterial ischemic stroke include cardiac disease, perinatal complications, and other acute illnesses, including dehydration and prothrombotic disorders. Mortality rates after arterial ischemic stroke in newborns are less than 10%. In many cases, the outcome is normal. Duplex imaging of the carotid vessels is feasible in neonates and can provide the treating physician with valuable diagnostic information.