title: Dynamic Arterial Compression in Pediatric Vertebral Arterial Dissection.
abstract: The pathogenesis of spontaneous pediatric vertebral artery dissections (VAD) is poorly understood but most often involves the V3 segment where C1 rotates on C2. We studied children with VAD with provocative digital catheter angiography and found an association between VAD and rotational compression.
  
  
  
  Seven boys (12 months to 9 years; median 4 years) presented over 38 consecutive months with V3 VAD and underwent digital catheter angiography with provocative passive bilateral neck rotation.
  
  
  
  VAD were bilateral in 2 patients and unilateral in 5. Provocative digital catheter angiography showed dynamic V3 compression in 6 of 9 dissections, most pronounced or seen only with head rotation to the contralateral side. Two patients had VAD without dynamic compression; both returned 4 months later with a new dissection in a previously normal VA and worsening VAD in 1 patient each. Dynamic compression was also seen in 2 nondissected VA. Surgical management was C1/2 posterior fusion in 5 of 7 patients; 1 underwent unilateral C2 decompression with recurrent VAD and was subsequently fused.
  
  
  
  The association of dynamic VA compression and VAD at the same level suggests that the compression may contribute to the VAD. However, as dynamic compression was observed in nondissected VA and some VAD were not associated with dynamic compression, VAD may be multifactorial.
authors.affiliation: From the Divisions of Pediatrics in the Departments of Radiology (N.R.), Neurosurgery (N.R., B.B.), and Neurology (M.D.), Children's Health System of Texas, University of Texas Southwestern Medical Center, Dallas; and Anesthesia for Children (A.H.) and Center for Cerebrovascular Disease in Children (S.B.), Children's Health System of Texas, Dallas. nancy.rollins@childrens.com.
authors.forename: Nancy
authors.initials: N
authors.lastname: Rollins
authors.affiliation: From the Divisions of Pediatrics in the Departments of Radiology (N.R.), Neurosurgery (N.R., B.B.), and Neurology (M.D.), Children's Health System of Texas, University of Texas Southwestern Medical Center, Dallas; and Anesthesia for Children (A.H.) and Center for Cerebrovascular Disease in Children (S.B.), Children's Health System of Texas, Dallas.
authors.forename: Bruno
authors.initials: B
authors.lastname: Braga
authors.affiliation: From the Divisions of Pediatrics in the Departments of Radiology (N.R.), Neurosurgery (N.R., B.B.), and Neurology (M.D.), Children's Health System of Texas, University of Texas Southwestern Medical Center, Dallas; and Anesthesia for Children (A.H.) and Center for Cerebrovascular Disease in Children (S.B.), Children's Health System of Texas, Dallas.
authors.forename: Amy
authors.initials: A
authors.lastname: Hogge
authors.affiliation: From the Divisions of Pediatrics in the Departments of Radiology (N.R.), Neurosurgery (N.R., B.B.), and Neurology (M.D.), Children's Health System of Texas, University of Texas Southwestern Medical Center, Dallas; and Anesthesia for Children (A.H.) and Center for Cerebrovascular Disease in Children (S.B.), Children's Health System of Texas, Dallas.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Beavers
authors.affiliation: From the Divisions of Pediatrics in the Departments of Radiology (N.R.), Neurosurgery (N.R., B.B.), and Neurology (M.D.), Children's Health System of Texas, University of Texas Southwestern Medical Center, Dallas; and Anesthesia for Children (A.H.) and Center for Cerebrovascular Disease in Children (S.B.), Children's Health System of Texas, Dallas.
authors.forename: Michael
authors.initials: M
authors.lastname: Dowling
mesh_terms: D002533:Cerebral Angiography / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D000072226:Computed Tomography Angiography / Q000379:methods*; D006801:Humans; D007223:Infant; D008297:Male; D012399:Rotation; D020217:Vertebral Artery Dissection / Q000000981:diagnostic imaging*
keywords: angiography; pediatrics; rotation; stroke; vertebral artery dissection