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<p>Congenital agenesis of the internal carotid artery (ICA) is a uncommon developmental anomaly that may remain clinically silent due to collateral circulation. In infants, however, inadequate collateralization can predispose to ischemic events particularly during systemic illness. We report an 11-month-old female who presented with acute-onset right sided hemiparesis in the setting of sepsis. CT angiography demonstrated complete absence of the left ICA with preservation of the external carotid artery. Axial skull base CT in bone window revealed absence of the left carotid canal, confirming congenital ICA agenesis and excluding acquired arterial occlusion. Collateral intracranial supply was provided via the vertebro-basilar circulation and ophthalmic artery branches. This case highlights the critical role of skull base imaging in differentiating congenital ICA agenesis from thrombosis or dissection in infants presenting with stroke and underscored an important diagnostic pitfall in pediatric neurovascular imaging.</p>

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Congenital internal carotid artery agenesis in an infant presenting with stroke: importance of carotid canal assessment

  • 期刊论文

  • 发表日期：

    2026年4月24日

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  • Mohammad Hashim,
  • Saransh Puri,
  • Sumit Kumar,
  • Natasha Gupta,
  • Shuchi Bhatt,
  • KNaga Anvesh

摘要

Congenital agenesis of the internal carotid artery (ICA) is a uncommon developmental anomaly that may remain clinically silent due to collateral circulation. In infants, however, inadequate collateralization can predispose to ischemic events particularly during systemic illness. We report an 11-month-old female who presented with acute-onset right sided hemiparesis in the setting of sepsis. CT angiography demonstrated complete absence of the left ICA with preservation of the external carotid artery. Axial skull base CT in bone window revealed absence of the left carotid canal, confirming congenital ICA agenesis and excluding acquired arterial occlusion. Collateral intracranial supply was provided via the vertebro-basilar circulation and ophthalmic artery branches. This case highlights the critical role of skull base imaging in differentiating congenital ICA agenesis from thrombosis or dissection in infants presenting with stroke and underscored an important diagnostic pitfall in pediatric neurovascular imaging.