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Early Wallerian Degeneration in a Neonate With Middle Carotid Artery Stroke

      A 23-day-old girl with a history of transposition of the great arteries, ventricular septal defect, pulmonary stenosis, and placement of right modified Blalock-Taussig shunt complicated by thrombosis at age 9 days of life presented with episodes of upper extremity extension and gasping respirations concerning for seizure. Brain magnetic resonance imaging demonstrated an extensive, acute right middle carotid artery territory stroke with occlusion of the right proximal middle carotid artery. There was also a small left frontal stroke. Diffusion restriction abnormalities with simultaneous presence of hyperintensity on T2 sequences in the corticospinal tract consistent with early Wallerian degeneration were observed (Figure).
      • Bekiesinska-Figatowska M.
      • Duczkowski M.
      • Madzik J.
      • Uliasz M.
      • Zawadka A.
      • Baszczeska J.
      Diffusion-weighted imaging of the early phase of Wallerian degeneration. A report of two pediatric cases and literature review.
      Figure thumbnail gr1
      FigureInitial brain magnetic resonance imaging at 22 days of age revealed diffusion restriction abnormalities in the right middle carotid artery territory (A). Wallerian degeneration within the right corticospinal tract at the level of internal capsule (A), midbrain (B), rostral pons (C), and caudal pons (D) is depicted by the arrow.
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