Perinatal arterial ischemic stroke related to carotid artery occlusion

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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 Volume 20, Issue 4, Pages 639-648 (July 2016) DOI: 10.1016/j.ejpn.2016.03.003 Copyright © 2016 European Paediatric Neurology Society Terms and Conditions

Fig. 1 (Case 1): Brain MRI performed on day 3 of life: (a) Coronal T2-weighted image shows a widespread loss of grey white matter differentiation in the right cerebral hemisphere (arrow). (b) Axial diffusion weighted image (DWI) shows extensive hypersignal involving the right hemisphere (arrow). These images confirm right acute diffuse hemispheric infarct. (c) Axial T1-weighted image shows high signal in the left cavernous internal carotid artery which is absent at the right side (arrow). (d) Coronal reconstruction of 3D TOF MRA confirms an extremely decreased flow with a poorly visualized right carotid internal artery (arrow). European Journal of Paediatric Neurology 2016 20, 639-648DOI: (10.1016/j.ejpn.2016.03.003) Copyright © 2016 European Paediatric Neurology Society Terms and Conditions

Fig. 2 (Case 1): Follow-up Brain MRI after 3 months. (a) Axial T1-weighted image shows cortical and sub-cortical atrophy with the subsequent ventricular enlargement and deformation of the posterior horn (arrow). (b) The persisting absence of flow in the right distal internal carotid artery (arrow) is seen on the coronal T2-weighted image. European Journal of Paediatric Neurology 2016 20, 639-648DOI: (10.1016/j.ejpn.2016.03.003) Copyright © 2016 European Paediatric Neurology Society Terms and Conditions

Fig. 3 (Case 4): Brain MRI performed on second day of life. (a) On Axial T2-weighted image, massive swelling of the left hemisphere with subfalcine herniation is well seen. (b) On the Apparent Diffusion Coefficient (ADC) Maps, diffusion restriction is present in both left anterior (ACA) and middle cerebral arteries (MCA) territories. (c) MRA sequences: non-visualization of the right common carotid artery and sub-occlusion of the left internal carotid (arrow). The right MCA and both ACAs are vascularised by the posterior circulation. European Journal of Paediatric Neurology 2016 20, 639-648DOI: (10.1016/j.ejpn.2016.03.003) Copyright © 2016 European Paediatric Neurology Society Terms and Conditions

Fig. 4 (Case 4): Haematoxylin and eosin stain of placenta showing (a) a chorionic plate vessel with a partially occlusive thrombus (b) areas of avascular villi with hyalinised fibrotic stroma, compatible with foetal thrombotic vasculopathy (magnification x40). European Journal of Paediatric Neurology 2016 20, 639-648DOI: (10.1016/j.ejpn.2016.03.003) Copyright © 2016 European Paediatric Neurology Society Terms and Conditions

Fig. 5 (Case 4): Follow-up MRI at one month. (a) Left hemispheric encephalomalacia is already evident on Axial T2-weighted sequences. (b) MRA show recanalisation of both carotids, yet with persistent sub-occlusive stenosis at the level of the right carotid bifurcation (arrow). European Journal of Paediatric Neurology 2016 20, 639-648DOI: (10.1016/j.ejpn.2016.03.003) Copyright © 2016 European Paediatric Neurology Society Terms and Conditions

Fig. 6 (Case 5): MRI on day 5. (a) On DWI sequences, an extensive right hemispheric stroke sparing the deep grey matter is well seen. There is in addition evidence of acute network injuries involving the entire corpus callosum and early sign of wallerian degeneration of the corticospinal tracts (CST), well demonstrated in (b) at the level of the cerebral peduncle. (c) Coronal reconstructed of 3D TOF MRA shows absent flow of the right internal carotid artery, but flow is visible along the right MCA. European Journal of Paediatric Neurology 2016 20, 639-648DOI: (10.1016/j.ejpn.2016.03.003) Copyright © 2016 European Paediatric Neurology Society Terms and Conditions

Fig. 7 (Case 5): MRI Axial T2-weighted images at 14 months. (a) Profound and diffuse cortical and subcortical atrophy of the right hemisphere is showed. Basal ganglia are partially preserved. b) Significant atrophy of the right cerebral peduncle is visible. European Journal of Paediatric Neurology 2016 20, 639-648DOI: (10.1016/j.ejpn.2016.03.003) Copyright © 2016 European Paediatric Neurology Society Terms and Conditions