Ischemic stroke following operated head trauma in children:
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Strokes are rare in the pediatric population. Posttraumatic strokes in children may be the result of several linked factors. Postoperative strokes may occur even several days after surgery thus extended follow-up is recommended. Children who are at risk of stroke should be detected early, based on the trauma process and effects.

Traumatic brain injury (TBI) is the leading cause of morbidity and mortality in children. TBI in children is responsible for a range of clinical symptoms and signs that are comparable to those in adults but present several differences in both physiopathology and management. Many postoperative complications are associated with TBI, stroke is one of the complications among the others. An ischemic stroke is generally related to intracranial artery injury.

The case of a child aged 3 years old, who was collided by a car causing a polytrauma with head and chest injury. On-body scan, she had a fracture of the sixth left rib and a frontal craniocerebral wound. The patient was operated on for debridement of the wound, and tight closure of the injured dura mater. The initial postoperative course was uneventful, but 5 days after the first surgery patient presented an acute onset of right hemiplegia followed by an alteration of her state of consciousness, and a left anisocoria.

Follow up CT scan showed a stroke of the whole left carotid territory. The patient was re-operated through a left decompressive craniectomy. Following the second surgery, she showed an improvement in her level of consciousness and a normalization of the size of her pupils, but aphasia and right hemiplegia persisted. 2 weeks after surgery, the patient had progressive necrosis of the surgical scar, followed by exposure of the underlying cerebral cortex. Despite intensive local care, plastic surgery to recover the wound, and antibiotics, the patient presented meningitis, followed by a septic shock and death.

Conclusively, ischemic stroke is probably the harshest and unpredictable complication that may occur after TBI, mainly in children. The only rigorous surgical approach followed by stringent post-operative care may prevent such outcomes.

International Journal of Surgery case reports