Symptomatic spontaneous vertebrobasilar dissections in children: review of 29 consecutive cases.
OBJECTIVE
The purpose of this study is to analyze the clinical presentation, morphological characteristics, angio-architecture, and outcome of vertebrobasilar dissection (VBD) in the pediatric population.


METHODS
The authors retrospectively reviewed 29 consecutive cases involving children younger than 16 years of age who were diagnosed with symptomatic VBDs. Data were gathered with respect to the patient's age, sex, clinical history, associated underlying disease, and symptoms (headache, vertigo) as well as the location of the dissection and the imaging appearance.


RESULTS
The patients' mean age was 8.24 years (range 2 months-15 years). There was an overall 3:1 male predominance, although among children older than 8 years, girls and boys were similarly affected. Hemorrhagic dissections occurred in 10 of 29 cases. In nonhemorrhagic dissections, stroke occurred in 16 cases, with the most common presenting symptoms being headaches and vertigo; in the other 3 cases, mass effect due to a chronic dissecting aneurysm was present. In 7 children an underlying vessel wall disease was found. The location of the dissection was extradural in 11 cases and intradural in the remainder. There was no preference with respect to side. The basilar artery was affected in 9 patients.


CONCLUSIONS
The imaging appearance and clinical presentation of symptomatic VBDs in the pediatric population differs from that in adults. Boys are more often affected, especially at younger ages, and hemorrhagic presentation is more common, presumably owing to the fact that the basilar artery is more commonly involved. Depending on the pathogenetic mechanism underlying the dissection, different clinical symptoms will evolve, necessitating individually tailored treatment.
Songsaeng
Dittapong
D
Service de Neuroradiologie Diagnostique Thérapeutique, Hôpital de Bicêtre-Université Paris-sud Orsay, Le Kremlin-Bicêtre, France.
Srivatanakul
Kittipong
K
Krings
Timo
T
Geibprasert
Sasikhan
S
Ozanne
Augustin
A
Lasjaunias
Pierre
P
D000293:Adolescent; D000784:Aortic Dissection / Q000473:pathology / Q000628:therapy; D001488:Basilar Artery; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D002532:Intracranial Aneurysm / Q000473:pathology / Q000628:therapy; D008297:Male; D012189:Retrospective Studies; D020521:Stroke / Q000209:etiology; D014711:Vertebral Artery