title: Atypical thoracic outlet syndrome and reverse flow thromboembolism.
abstract: BACKGROUND
  Thoracic outlet syndrome is rare in children but may have serious consequences. Compression of the neurovascular structures at the thoracic outlet by anomalous soft tissues or cervical ribs may cause neurological deficits in the upper limb and venous or arterial insufficiency.
  
  
  METHODS
  The symptoms and signs of this condition are well documented, but we describe two patients with an atypical presentation. We review similar published cases where delay in diagnosis resulted in cerebrovascular catastrophe. Our patients presented with relatively nonspecific central nervous system symptoms and were found to have thoracic outlet compression. Both were treated by surgical decompression of the thoracic outlet, and the symptoms completely resolved with no long-lasting neurological consequences.
  
  
  CONCLUSIONS
  We highlight the importance of these rare cases because of the risk of stroke and discuss the theory behind the pathological process.
authors.affiliation: Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Bains
authors.affiliation: Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Jennica
authors.initials: J
authors.lastname: Platt
authors.affiliation: Division of Neurology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Daune
authors.initials: D
authors.lastname: MacGregor
authors.affiliation: Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. Electronic address: gregory.borschel@sickkids.ca.
authors.forename: Gregory H
authors.initials: GH
authors.lastname: Borschel
mesh_terms: D000293:Adolescent; D002533:Cerebral Angiography; D002648:Child; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D013901:Thoracic Outlet Syndrome / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D013923:Thromboembolism / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery
keywords: migraine; stroke; thoracic outlet syndrome; thromboembolism