Introduction. Most arterial ischemic strokes in children are attributable to acquired vasculopathies, a significant subset of which are inflammatory in nature. The cervical carotid system in particular is often involved in Takayasu arteritis (TA), a systemic vasculitis that classically affects the aortic arch and its major branches. We discuss the case of a 16 year old girl with stroke and transient ischemic symptoms due to isolated inflammatory occlusive lesions of both carotid arteries.

Case Report. Our patient presented with stuttering onset of right-sided weakness and was found to have an acute ischemic stroke in the left basal ganglia and internal capsule. Labs were notable for elevated serum inflammatory markers. Vascular imaging demonstrated severe occlusive disease of both common carotid arteries, without involvement of the aortic arch or other branches. Her disease initially progressed, but stabilized with anticoagulation, antiplatelet therapy, corticosteroids, methotrexate, and cyclophosphamide. She subsequently presented with transient left-sided symptoms correlated with decreased perfusion in the territory of the right internal carotid artery.

Discussion. The common carotid arteries are among the most frequently affected vessels in TA. In children, approximately 52% of patients have common carotid involvement (1). However, isolated involvement of aortic branch vessels occurs in only 5% of cases (2), and isolated involvement of the common carotid arteries has not been reported to our knowledge.

Conclusions. Isolated inflammation of the common carotid arteries occurs in children and may present with ischemic stroke. A combination of aggressive antithrombotic, anti-inflammatory and immune-modifying therapy appears to halt disease progression.