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Hindbrain stroke in children caused by extracranial vertebral artery trauma
Insights
Hindbrain transient ischemic attacks (TIAs) in children can lead to posterior circulation stroke. Atlanto-axial instability may cause vertebral artery issues, suggesting a traumatic cause for these events.
Area of Science:
- Pediatric Neurology
- Vascular Neurology
- Neuroradiology
Background:
- Transient ischemic attacks (TIAs) and stroke in the posterior circulation of children are serious neurological events.
- Understanding the underlying etiology is crucial for effective management and prevention.
- Atlanto-axial subluxation is a rare condition affecting the upper cervical spine.
Observation:
- Five children presented with hindbrain TIAs progressing to posterior circulation stroke.
- One patient had atlanto-axial subluxation with C1-C2 arterial pathology.
- Four similar cases showed posterior fossa TIAs, stroke, and basilar artery abnormalities.
Findings:
- A mechanical traumatic etiology is proposed for these cases.
- Extracranial vertebral artery stenosis or occlusion secondary to atlanto-axial instability is a potential cause.
- Recurrent brainstem or cerebellar symptoms may indicate this underlying pathology.
Implications:
- Early identification and documentation of atlanto-axial instability are vital.
- Stabilization of atlanto-axial instability may prevent recurrent TIAs and stroke.
- This highlights a specific, potentially preventable cause of pediatric posterior circulation stroke.
Abstract:
Hindbrain transient ischemic attacks (TIAs) culminating in posterior circulation stroke are described in five children. Atlanto-axial subluxation and angiographical documentation of C1 to C2 level arterial pathology are documented in one patient. Four additional patients with nearly identical clinical presentations, posterior fossa TIAs, stroke and basilar angiographical pathology are reviewed. A mechanical traumatic etiology is suggested. Unexplained transient repeated brain stem and/or cerebellar sympotomatology may be due to extracranial vetebral artery stenosis or occlusion by atlanto-axial instability. After appropriate documentation, stabilization may prevent further TIAs or strokes.