Introduction: Dissection of the carotid arteries is an important cause of ischaemic stroke in childhood. Rarely, blunt trauma to the soft palate can result in an internal carotid artery (ICA) dissection leading to thrombosis, embolism and stroke.
Case presentation: A 10-month-old child was admitted to hospital having presented with minor intra-oral trauma following a fall from a sofa whilst carrying a spoon in her mouth. After an interval, the child's level of consciousness decreased. Computed tomography and magnetic resonance imaging of the brain and neck revealed occlusion of the left ICA, oedema of the perivascular tissues and cerebral ischaemia in the left middle cerebral artery territory.
Conclusion: A carotid artery dissection after minor trauma to the soft palate is a rare, but potentially severe complication. The combination of minor precipitating trauma, prolonged symptom-free intervals and complexity of clinical neurological assessment in small children contributes to a difficult diagnostic dilemma.