title: Pediatric Homonymous Superior Quadrantanopia in the Presence of Acute Vertebral Artery Dissection.
abstract: OBJECTIVE
  Spontaneous dissection of the vertebral artery is a dangerous and often underdiagnosed cause of posterior circulation and occipital lobe stroke in the young. Vertebral artery dissection should be considered in young patients with a history of minor, nontraumatic changes in head position and visual disturbances.
  
  
  METHODS
  Clinical records for this patient were retrospectively reviewed at Miami Children's Hospital and associated pediatric ophthalmology clinic.
  
  
  RESULTS
  A previously healthy 8-year-old boy presented to the emergency department with a 2-day history of headache and blurred vision that developed after going on a high-velocity amusement park ride. Confrontation visual field testing showed a subtle superior visual field deficit superiorly. Computer topography scan of the head without contrast was performed and showed bilateral occipital hypodense lesions consistent with ischemic infarction. A filling defect was seen in the transverse portion of the right vertebral artery at the level of C2 as it exited the right transverse foramen, consistent with an acute arterial dissection at this level. Automated visual field testing showed macular sparing left homonymous superior quadrantanopia.
  
  
  CONCLUSIONS
  Most patients with vertebral artery dissection present with signs of posterior circulation ischemia consisting of neurological deficits, headaches, or neck pain. This case report highlights the unique clinical features and diagnostic imaging seen in the work-up of this rare disease process and exemplifies the importance of identifying acute visual symptoms in an emergency situation.
authors.affiliation: From the *Florida International University Herbert Wertheim College of Medicine; †Miami Children's Hospital, Florida International University Herbert Wertheim College of Medicine and ‡Pediatric Ophthalmology Consultants, Bascom Palmer Eye Institute, Miami, FL.
authors.forename: Dante
authors.initials: D
authors.lastname: Sorrentino
authors.forename: Jefry L
authors.initials: JL
authors.lastname: Biehler
authors.forename: Roberto
authors.initials: R
authors.lastname: Warman
mesh_terms: D002545:Brain Ischemia / Q000175:diagnosis; D002648:Child; D017984:Enoxaparin / Q000627:therapeutic use; D006423:Hemianopsia / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D020217:Vertebral Artery Dissection / Q000175:diagnosis* / Q000503:physiopathology; D058609:Visual Field Tests; D014794:Visual Fields / Q000502:physiology
chemical_list: D017984:Enoxaparin