title: Internal carotid artery stenosis as the sequela of a pseudoaneurysm after methicillin-resistant Staphylococcus aureus infection.
abstract: Pseudoaneurysm of the internal carotid artery is an extremely uncommon complication of pediatric deep neck space infections in the postantibiotic era, and poses a diagnostic challenge to clinicians. Early recognition and aggressive management are essential to prevent mortality and serious morbidity. We describe a pseudoaneurysm of the left internal carotid artery after a retropharyngeal abscess in an infant. The retropharyngeal abscess required surgical drainage, and the pseudoaneurysm was managed conservatively with antibiotic therapy. The patient developed 50% stenosis of the left internal carotid artery after recovery. Limited data are available about long-term outcomes of pseudoaneurysms of the internal carotid artery. During 7-year follow-up, she demonstrated no neurologic sequelae and normal development. Despite the left internal carotid artery stenosis, blood supply to the left cerebral hemisphere is well maintained through the circle of Willis. We highlight the importance of early recognition and aggressive management to avoid serious outcomes.
authors.affiliation: Department of Pediatrics, Louisiana State University Health Sciences Center, Shreveport, Louisiana 71130, USA. drsskumar@gmail.com
authors.forename: Senthilkumar
authors.initials: S
authors.lastname: Sankararaman
authors.forename: Sujithra
authors.initials: S
authors.lastname: Velayuthan
authors.forename: Eduardo
authors.initials: E
authors.lastname: Gonzalez-Toledo
mesh_terms: D017541:Aneurysm, False / Q000150:complications*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002340:Carotid Artery Diseases / Q000150:complications*; D002343:Carotid Artery, Internal / Q000473:pathology* / Q000503:physiopathology; D016893:Carotid Stenosis / Q000209:etiology* / Q000503:physiopathology; D002560:Cerebrovascular Circulation; D002941:Circle of Willis / Q000503:physiopathology; D003131:Combined Modality Therapy; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery; D004322:Drainage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000209:etiology; D007223:Infant; D008480:Mediastinitis / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D010033:Otitis Media / Q000150:complications; D012008:Recurrence; D017703:Retropharyngeal Abscess / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery; D013203:Staphylococcal Infections / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery
chemical_list: D000900:Anti-Bacterial Agents; D000925:Anticoagulants; D000959:Antihypertensive Agents