title: Perinatal arterial ischemic stroke related to carotid artery occlusion.
abstract: BACKGROUND
  The aetiology of perinatal arterial ischemic stroke remains speculative. It is however widely accepted that the aetiology is multifactorial, involving various maternal, placental, foetal and neonatal risk factors. A resulting thromboembolic process is hypothesized and the placenta identified as the most plausible source. An arteriopathy, as observed in a significant proportion of childhood ischemic stroke, is thought to be rare.
  
  
  METHODS
  We report here five cases of perinatal stroke that differ from the vast majority by documented carotid occlusion, and add eleven other similar cases from the literature.
  
  
  RESULTS
  In the majority, an intraluminal thrombus of placental origin is the most probable hypothesis, while in the remaining ones, one can reasonably presume a direct vessel wall injury related to a traumatic delivery, yet generally unproven by imaging.
  
  
  CONCLUSIONS
  We hypothesize that most of these cases share similar pathophysiology with the more common perinatal arterial ischemic stroke but differ by a persistent identified thrombus in the carotid artery at the time of first imaging, leading to a more severe and extended ischemic damage responsible for an adverse neurological outcome.
authors.affiliation: Pediatric Neurology Unit, Pediatric Subspecialities Service, Children's Hospital, Geneva University Hospitals, Switzerland. Electronic address: joel.fluss@hcuge.ch.
authors.forename: Joel
authors.initials: J
authors.lastname: Fluss
authors.affiliation: Pediatric Neurology Unit, Pediatric Subspecialities Service, Children's Hospital, Geneva University Hospitals, Switzerland.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Garcia-Tarodo
authors.affiliation: Neonatal Unit, Sud-Francilien Hospital Centre, Corbeil, France.
authors.forename: Michèle
authors.initials: M
authors.lastname: Granier
authors.affiliation: Pediatric Neurology, Children's Hospital, Bordeaux University Hospital, Bordeaux, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Villega
authors.affiliation: Unit of Pediatric Radiology, Children's Hospital, Geneva University Hospitals, Switzerland.
authors.forename: Solène
authors.initials: S
authors.lastname: Ferey
authors.affiliation: French Centre for Pediatric Stroke and Pediatric Radiology, Bicêtre University Hospital Centre, Le Kremlin-Bicêtre, France.
authors.forename: Béatrice
authors.initials: B
authors.lastname: Husson
authors.affiliation: French Centre for Pediatric Stroke, Pediatric Neurology Department, APHP-Necker-Enfants Malades, University Hospital, Paris, France.
authors.forename: Manoelle
authors.initials: M
authors.lastname: Kossorotoff
authors.affiliation: Neonatal Unit, Department of Pediatrics, Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: Vincent
authors.initials: V
authors.lastname: Muehlethaler
authors.affiliation: Pediatric Neurology Unit, Department of Pediatrics, Lausanne University Hospital, Switzerland.
authors.forename: Sebastien
authors.initials: S
authors.lastname: Lebon
authors.affiliation: French Centre for Pediatric Stroke, University Hospital Centre of Saint-Etienne, 42055 Saint-Etienne Cedex 2, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Chabrier
mesh_terms: D001157:Arterial Occlusive Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D001921:Brain / Q000000981:diagnostic imaging*; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000209:etiology; D002339:Carotid Arteries / Q000000981:diagnostic imaging*; D002340:Carotid Artery Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D002533:Cerebral Angiography; D002547:Cerebral Palsy / Q000209:etiology; D002658:Developmental Disabilities / Q000209:etiology; D004828:Epilepsies, Partial / Q000209:etiology; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008607:Intellectual Disability / Q000209:etiology; D018810:Magnetic Resonance Angiography; D008297:Male; D010920:Placenta / Q000473:pathology; D011247:Pregnancy; D012307:Risk Factors; D020521:Stroke / Q000000981:diagnostic imaging* / Q000209:etiology
keywords: Carotid occlusion; Dissection; Neonatal arterial ischemic stroke; Perinatal stroke; Placental thromboembolism