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Related Experiment Videos

Vertebral artery dissection in children: a comprehensive review.

Izhar Hasan1, Simon Wapnick, Michael S Tenner

  • 1Department of Neurosurgery, New York Medical College, Valhalla and New York, N.Y., USA.

Pediatric Neurosurgery
|October 10, 2002
PubMed
Summary

Vertebral artery dissection (VAD) in children is often linked to sports neck movements and presents differently than in adults. Antiplatelet therapy showed better outcomes than anticoagulation for pediatric VAD patients.

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Area of Science:

  • Pediatric Neurology
  • Vascular Medicine
  • Sports Medicine

Background:

  • Vertebral artery dissection (VAD) is rarely diagnosed in pediatric populations.
  • Existing literature on pediatric VAD is limited, necessitating further review and analysis.
  • Understanding VAD in children is crucial due to its distinct presentation and potential sequelae compared to adults.

Purpose of the Study:

  • To review and analyze reported cases of VAD in children.
  • To identify common causes, clinical presentations, diagnostic methods, and treatment outcomes for pediatric VAD.
  • To highlight the association between VAD and cervical anomalies in children.

Main Methods:

  • Systematic literature review of 68 reported pediatric VAD cases.
  • Analysis of patient demographics, clinical symptoms, diagnostic imaging (angiography, MRA), associated cervical abnormalities, and treatment strategies.

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  • Comparison of treatment outcomes based on therapy type (antiplatelet vs. anticoagulation).

    • Main Results:

    • VAD in children is associated with sports-related neck movements in 50% of cases.
    • Pediatric VAD predominantly affects boys (6.6:1 ratio) and presents with ataxia, headache, and vomiting, unlike adults who typically present with neck pain.
    • Angiography is the primary diagnostic tool; MRA has limited diagnostic yield (23%). Skeletal abnormalities in the occipital/atlas/axis region are common (50% of those with recorded X-rays).
    • Antiplatelet therapy resulted in an 80% asymptomatic recovery rate, significantly higher than anticoagulation (27%).

    Conclusions:

    • Pediatric VAD has unique characteristics, including a strong link to sports and distinct symptomatology.
    • A high incidence of associated cervical anomalies warrants further investigation.
    • Antiplatelet therapy appears more effective than anticoagulation for pediatric VAD, though optimal treatment strategies require further research.