446
Internal Carotid
An
Case
A
Thrombus:
Report
Artery
Source
withthe
wastransferredto MiamiChildren’s
3-day-old
diag-
boy
Hospital
ofan
Underdiagnosed
nosis ofseizures and
He
the
was
product
uncomplicated
hypotonia.
for
ofBrain
Emboli
in
Neonates?
last weekof
the
and
maternalfever
delivery, except
pregnancy
pregnancy.
during
1
was
scoreswere
9
and
9
at and
5
minutes.
Birthweight
nor-
cm. General examination was
35.5
Apgar
Headcircumference
ABSTRACT
3.65
was
kg.
mal. Bloodcultureswere
andthe
wasstarted onintravenous
done,
patient
and
ampicillin
gentamicin.
We
a
full-term neonate with
a
left middle cerebral
artery
report
of
At
3
of
hehadseveral
ofthe
trunk, repet-
examina-
days
itive limbs
episodes
age,
arching
gaze.
of
the internal
detected
artery
carotid
infarct,
netic resonance
narrowing
by
mag-
left lateral
and sustained
movements,
Physical
andB-mode
and
a
ultrasonography,
angiography
a
full anterior
tionrevealed
a
neonatewith
no
hypoactive
minimal
fontanelle,
and
The rest
poor
rooting
of
largethrombusatthe
B-mode
oftheinternal carotid
detected
the
artery
arterial
origin
reflex,
reflex,
hypotonia,
grasp.
revealednormal
sucking
wasnormal.
serum
examination
Internal carotid
thrombusis
Laboratoryinvestigation
electrolytes. Anunenhanced
by
ultrasonography.
consideredthesourceofmiddlecerebral
and
calcium,
of thebrain
computedtomography
glucose,
(CT)
seldom
arterial
embolus
a
infarct.
and
revealed
Phenobarbital
left-hemisphere
large
in
ofthe
neonates. We
thatB-mode
carotid
ultrasonography
evaluation ofmiddlecerebral
suggest
beincludedinthe
werestarted becauseof
seizures.
suspectedfrequent
fosphenytoin
artery
artery
diagnostic
neonates. ChildNeurol
Theinitial
examinationatMiamiChildren’s
revealed
physical
Hospital
in
infarcts
a
in no acute distress. Head circumference was35.5 cm. The ante-
(J
2001;16:446-447).
patient
was
riorfontanellewasfull. Therestofthe
examination
normal
except
general
a
III/IV
for
murmur. The
examinationwas
grade
systolic ejection
depressed
neurologic
levelof
alertness, poorsucking,
and
remarkablefor
a
generalized
a
revealed
count of
The
platelet
A
hypotonia.
677,000/jjLL.
consisting
laboratory
investigation
Mostfocal arterialischemicinfarcts infull-termneonatesinvolve
White
redbloodcell werenormal.
and
counts
antithrombin
S,
panel
coagulation
and factor
V
of
C and
the middlecerebral
Thecause
middle
III,
distribution.
of
cere-
protein
plasminogen,
artery
A
lev-
antibody
Leidenwasnormal.
panel,
lupuserythematous
cardiac
anticardiolipin
and
placental
bral
an
in
infarcts
full-termneonatesis oftennotfound
artery
despite
exami-
els, antiphospholipid antibodies,
ultrasound,
exhaustive
This
includes
investigation.
studies, lupus erythematous panel,
investigation
coagula-
did
levels
nation
not reveal
Phenobarbital and
anyabnormality.
phenytoin
placed
tion
anticardiolipin antibody
were in the
On
the
was
on con-
therapeutic range.
four-channel
arrival,
patient
cardiac
antibodies,
Con-
level,
antiphospholipid
andbrain
ultrasound, placental
tinuous-display
tinuousvideoEEG
electroencephalographic(EEG)monitoring.
wasstartedseveralhourslater. Phenobarbital
studies. 1,2 B-mode
telemetry
examination,
imaging
ultrasonography
of the carotid arteries is seldom
in the evaluation of
performed
with
neonates
with
middlecerebral
infarct. We
a
neonate
artery
present
a
leftmiddlecerebral
detected
infarct andinternal
carotid
artery
resonance
artery
andB-mode
by
pathology
magnetic
angiography
ultrasonography.
narrow
brain:
left
1.
resonance
in
resonance
of the brain: infarct
the dis-
Figure
Magnetic
Figure 2.
Magnetic
angiography of the
middle
the left
and absence of
imaging
cerebral
internal carotid
tribution of the left middle cerebral
artery.
artery
artery.
Fang
