Perinatal arterial ischemic stroke related to carotid artery occlusion

- Carotid occlusion is a rare cause of perinatal arterial ischemic stroke (PAIS).
- Two distinct mechanisms may underlie carotid occlusion: 1) large persistent placenta emboli 2) vessel wall injury.
- Poor outcome in PAIS is the setting of carotid occlusion is likely related to larger stroke sizes than commonly encountered.
- This unique series give insight in the understanding of the pathophysiology of PAIS.

BackgroundThe 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.MethodsWe 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.ResultsIn 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.ConclusionWe 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.