Diagnosis of vertebral artery dissection in childhood posterior circulation arterial ischaemic stroke.
OBJECTIVE
Review a series of children with posterior circulation arterial ischaemic stroke (PCAIS) to identify diagnostic modality and associations in cases of vertebral artery dissection (VAD).


METHODS
Retrospective analysis of 30 cases of childhood PCAIS identified from two tertiary centres over 11 years. Clinical and demographic details were recorded. Brain and cerebrovascular imaging were reviewed. Aetiology was classified using the Childhood Arterial Ischaemic Stroke Standardized Classification and Diagnostic Evaluation criteria. Outcome was evaluated using standardized paediatric stroke outcome scores. Logistic regression was used to explore variables associated with diagnosis.


RESULTS
Twenty-three patients were male (77%) and 7 were female (23%). VAD was the most commonly identified aetiology, in 15 cases (50%). Aetiology was undetermined in 12 (40%), probable cardioembolism in two, and reversible cerebral vasoconstriction syndrome in one. In those with VAD, diagnosis was made on initial magnetic resonance angiography (MRA) in six (40%). Further cases of VAD were diagnosed with catheter angiography (n=6), computed tomographic angiography (n=1), or follow-up MRA (n=2). Presence of multiple infarcts was associated with a diagnosis of VAD.


CONCLUSIONS
Endoluminal cerebrovascular imaging increases the rate of diagnosis of VAD in childhood PCAIS and should especially be considered if there are multiple infarcts.
Department of Neurosciences, Great Ormond Street Hospital, London, UK.
Nadine
N
McCrea
Department of Radiology, Great Ormond Street Hospital, London, UK.
Dawn
D
Saunders
Population, Policy and Practice Programme, UCL Institute of Child Health, London, UK.
Emmanouil
E
Bagkeris
Department of Paediatric Neurology, Addenbrooke's Hospital, Cambridge, UK.
Manali
M
Chitre
Neurosciences Unit, UCL Institute of Child Health, London, UK.
Vijeya
V
Ganesan
D000293:Adolescent; D002545:Brain Ischemia / Q000175:diagnosis / Q000209:etiology*; D002560:Cerebrovascular Circulation / Q000502:physiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis / Q000209:etiology*; D020217:Vertebral Artery Dissection / Q000150:complications* / Q000175:diagnosis