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Arterial dissection and stroke in children.

H J Fullerton1, S C Johnston, W S Smith

  • 1Department of Neurology, University of California, San Francisco 94143-0114, USA. hjfc@itsa.ucsf.edu

Neurology
|October 17, 2001
PubMed
Summary
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Pediatric cerebral arterial dissections show a strong male predominance, unrelated to trauma. Unlike adults, dissections in children, especially spontaneous ones, are often intracranial, with the vertebral artery being a common site.

Area of Science:

  • Neurology
  • Pediatric Medicine
  • Vascular Surgery

Background:

  • Cerebral arterial dissections (CAD) are a significant cause of stroke in children.
  • Understanding the specific characteristics of CAD in pediatric populations is crucial for diagnosis and management.

Purpose of the Study:

  • To delineate the clinical features of cerebral arterial dissections in children.
  • To compare anterior circulation arterial dissections (ACAD) and posterior circulation arterial dissections (PCAD) in pediatric patients.

Main Methods:

  • Systematic literature search of MEDLINE and bibliographies for English-language studies.
  • Inclusion of patients under 18 years old diagnosed with ACAD or PCAD.
  • Review of 2,027 studies identifying 118 pediatric patients.

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Main Results:

  • A marked male predominance was observed in both ACAD (74%) and PCAD (87%), persisting even when trauma was excluded.
  • All patients presented with cerebral ischemia; headache was reported in approximately half.
  • Intracranial ACAD were more common (60%), particularly in spontaneous cases (86%), while post-traumatic ACAD were often extracranial (25%).
  • The C1-C2 vertebral artery segment was the most frequent site for PCAD (53%).
  • Recurrent ischemic events occurred in 15% of PCAD and 5% of ACAD cases; recurrent dissections were rare.

Conclusions:

  • Pediatric cerebral arterial dissections exhibit a significant male predominance not attributable to trauma.
  • Childhood ACAD are predominantly intracranial, contrasting with adult patterns.
  • Spontaneous ACAD are typically intracranial, whereas post-traumatic ACAD are more frequently extracranial.
  • The most vulnerable vertebral artery segment in children mirrors that in adults.