Severe Pediatric Polytrauma Complicated by Stroke After Fall From Swamp Buggy

Blunt cerebrovascular injuries (BCVIs) are rare but potentially severe complications of blunt trauma and can lead to acute ischemic stroke. Diagnosis requires imaging but necessitates more cautious consideration in pediatrics due to radiation concerns. Management options span observation, anticoagulation, and various endovascular interventions, but decisions are complicated by limited literature and the presence of other traumatic injuries. Further collaborative research is needed to provide clarity when caring for pediatric patients with BCVI to guide diagnosis and management. A four-year-old male with no significant past medical history presented to the emergency department as a trauma activation secondary to injuries sustained after falling from a moving "swamp buggy" recreational vehicle. He was found to have severe craniofacial and cervical spine injuries including open bilateral mandibular fractures, C2-C3 distraction injury with associated spinal cord injury, and blunt left common carotid injury subsequently complicated by a left hemispheric stroke with right hemiplegia. Management challenges arose due to the complexity of injuries, with decisions regarding management of initial injuries and subsequent stroke treatment being particularly intricate. The patient underwent various interventions, including closed reduction of spinal fractures, halo vest placement, mandibular fracture repair and ultimately open internal fixation of spinal fractures via spinal fusion. Despite the severity of injuries, the patient had a positive outcome, underscoring the importance of multidisciplinary collaboration in trauma care. This is an uncommon injury presentation in a pediatric patient and this case was highlighted to demonstrate the diagnostic and treatment challenges regarding blunt cerebrovascular injuries in pediatric patients. Further research is needed to guide physicians caring for pediatric patients with blunt cerebrovascular injuries and the sequela of such injuries.