Carotid thrombosis in childhood.

Although carotid occlusive disease is not uncommon in adults (Fisher, 1954; Samuel, 1956), it is rare in children. Since atherosclerosis is accepted by most authors as the major aetiological agent, this is not surprising. A search of the literature reveals 16 cases of carotid occlusion in persons 10 years of age or less (Duffy, Portnoy, Mauro and Wehrle, 1957; Cabieses and Saldias, 1956; Behrman, 1954; Shapiro, 1952; King and Langworthy, 1941; Litchfield, 1938; Gross, 1945; Martin, Lukeman, Ranson and Geppert, 1954; Goldstein and Burgess, 1958; Pouyanne, Arne, Loiseau and Mouton, 1957; Clark and Linell, 1954; Braudo, 1956; Fairburn, 1957) and a further six below the age of 20 (Pouyanne et al., 1957; Krayenbiihl and Weber, 1944; Petit-Dutaillis, Janet, Thiebaut and Guillaumat, 1949; Riechert, 1938; Caldwell, 1936). Arteriographic, necropsy or operative proof was provided in 17 of these cases; two were diagnosed on the absence of carotid pulsation on the side opposite the hemiplegia and three, associated with trauma, were accepted on convincing circumstantial grounds. An aetiology was indicated in 13 cases. Litchfield (1938) and Pouyanne et al. (1957) have each reported a case associated with severe throat infection. Gross (1945), in a review of arterial occlusion in infancy, reported two cases in whom emboli from a thrombosed persistent ductus arteriosus were considered to have caused the occlusion. One of these cases also had Fallot's tetralogy with polycythaemia. A paradoxical embolus of necrotic placental tissue was presumed by Clark and Linell (1954) to have caused internal carotid occlusion in an infant with erythroblastosis foetalis. In the case reported by Duffy et al. (1957) thrombosis was probably due to a congenital anomaly of the vessel wall. Martin et al. (1954) have described a case of mucormycosis of the central nervous system in which the thrombosed internal carotid artery was heavily invaded by the organism. Riechert's case (1938) appears to have been related to the presence of a nearby intracranial tumour. Trauma accounted for five cases (Braudo, 1956; Fairburn, 1957; Caldwell, 1936), direct injury to the soft palate being responsible in each instance. In all of the proven cases the occlusion was limited to one or other internal carotid artery; one of the others (King and Langworthy, 1941) was thought to have common carotid and right subclavian obstruction on clinical grounds. Bilateral carotid involvement is occasionally encountered (Ochs, Sensenbach and Madison, 1954; Batley, 1955; Silverstein, 1959; Brain, 1957), but has never previously been reported in a child. Common carotid thrombosis constitutes a small fraction of several series of carotid occlusive cases (Silverstein, 1959; Shapiro and Peyton, 1954; Ameli and Ashby, 1949; Gurdjian and Webster, 1953) but no proven case in childhood has yet been reported. The following case of a child with bilateral common carotid thrombosis may thus be worth reporting.