title: Extracranial vertebral artery dissection in children: natural history and management.
abstract: BACKGROUND
  The objective of this study is to describe clinical and imaging presentation and outcome in extracranial vertebral artery dissection.
  
  
  METHODS
  Single-centre retrospective study over a 14-year period included 20 consecutive patients under the age of 16 years with extracranial vertebral artery dissection. The diagnosis was based on vascular imaging performed at the acute phase and clinical symptoms.
  
  
  RESULTS
  A male predominance was observed (sex ratio 9/1). The first symptoms consisted of headache (45%), neck pain (15%), nausea (30%) and vertigo (30%). Clinical signs leading to admission to hospital were hemiparesis (60%), visual disorders with oculomotor disorders (20%) or visual field defects (20%) and cerebellar syndrome (35%). Eight patients (40%) reported repeated transient episodes of neurological deficits, prior to the diagnosis. The segment most commonly affected was V2-V3 (50%), followed by V3 (15%) and V2 (15%), V3-V4 (10%) and proximal V4 (10%). All patients but one presented cerebral infarction. Eleven patients received first-line treatment with low molecular weight heparin (LMWH), and nine patients received aspirin. Three patients experienced a recurrence of symptoms, one under vitamin K antagonist (VKA) and 2 under aspirin. All three were switched to LMWH with success. Fifty-eight percent of the dissected arteries were occluded at long-term follow-up, although 73% of them were patent at the acute phase.
  
  
  CONCLUSIONS
  Initial imaging must include posterior fossa vessels and the craniocervical region with V2-V3 segments. Conventional angiography may be indicated in the absence of a definitive diagnosis on noninvasive imaging. Healing of the dissected vertebral artery predominantly resulted in occlusion, which does not constitute a pejorative factor but indicates good quality healing.
authors.affiliation: Neurologie Pédiatrique, Hôpital Bicêtre, Le Kremlin Bicêtre, Paris, France.
authors.forename: Hina
authors.initials: H
authors.lastname: Simonnet
authors.forename: Kumaran
authors.initials: K
authors.lastname: Deiva
authors.forename: Céline
authors.initials: C
authors.lastname: Bellesme
authors.forename: Sébastien
authors.initials: S
authors.lastname: Cabasson
authors.forename: Béatrice
authors.initials: B
authors.lastname: Husson
authors.forename: Frédérique
authors.initials: F
authors.lastname: Toulgoat
authors.forename: Marie
authors.initials: M
authors.lastname: Théaudin
authors.forename: Denis
authors.initials: D
authors.lastname: Ducreux
authors.forename: Marc
authors.initials: M
authors.lastname: Tardieu
authors.forename: Guillaume
authors.initials: G
authors.lastname: Saliou
mesh_terms: D000293:Adolescent; D000925:Anticoagulants / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D002533:Cerebral Angiography; D002648:Child; D002675:Child, Preschool; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D018810:Magnetic Resonance Angiography; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012189:Retrospective Studies; D016896:Treatment Outcome; D020217:Vertebral Artery Dissection / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D014812:Vitamin K / Q000037:antagonists & inhibitors / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D010975:Platelet Aggregation Inhibitors; D014812:Vitamin K; D001241:Aspirin
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