Craniocervical arterial dissection in children: clinical and radiographic presentation and outcome.
Craniocervical arterial dissection is a recognized cause of arterial ischemic stroke in children. Whether children with craniocervical arterial dissection have dissection characteristics different from those of adults is unclear. A retrospective review of children, 1 month to 18 years of age, with dissection from two Canadian pediatric ischemic stroke registry centers was conducted. From 213 patients with arterial ischemic stroke, 16 (7.5%) were identified with dissection, 37.5% had warning symptoms, and 50% had a history of head or neck trauma. The clinical presentation included headache (44%), altered consciousness (25%), seizures (12.5%), and focal deficits (87.5%). Dissection involved extracranial vessels in 75% and anterior circulation in 56%. Follow-up included complete recovery in 43%, mild to moderate deficits in 44%, and severe deficits in 13%. Fourteen (87.5%) children received antithrombotic treatment. Follow-up angiography showed resolution of abnormalities in 60% of vessels. Total occlusion had the worst outcome for recanalization. In conclusion, the etiology of arterial dissection in the majority of children appears to be either trauma or idiopathic. Long-term angiography shows variable outcomes, depending on the initial findings. The relationship of angiographic outcomes with recurrent strokes requires further study in pediatric dissection. (J Child Neurol 2006;21:8-16).
Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada.
Mubeen F
MF
Rafay
Derek
D
Armstrong
Gabrielle
G
Deveber
Trish
T
Domi
Anthony
A
Chan
Daune L
DL
MacGregor
D000293:Adolescent; D000784:Aortic Dissection / Q000150:complications* / Q000175:diagnosis*; D000792:Angiography / Q000379:methods; D002536:Cerebral Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology*; D020214:Cerebrovascular Trauma / Q000150:complications* / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D016896:Treatment Outcome