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[Dissection of the sylvian artery with resulting aneurysm in a 6 years old child]
D Graber1, V Flurin-Chollet, Y Chaix
1Service de Médecine Infantile A, CHU Purpan.
Insights
Childhood arterial dissection, though rare, can occur spontaneously. This case highlights its potential to lead to aneurysm formation, a known complication of cervical artery dissection.
Area of Science:
- Pediatric Neurology
- Vascular Surgery
- Neuroradiology
Background:
- Arterial dissection of cervical and cerebral vessels is an uncommon condition in pediatric patients.
- Prompt diagnosis and management are crucial for favorable outcomes.
Observation:
- A 6-year-old girl presented with sudden loss of consciousness and seizure post-fall.
- Initial CT scans were normal, but a later scan revealed a low-density area in the middle cerebral artery territory.
- Arteriography demonstrated wall irregularities suggestive of dissection, leading to aneurysm formation over time.
Findings:
- Cerebral artery dissection in a child without apparent cause.
- Development of a large aneurysm secondary to arterial dissection.
- Persistent hemiplegia despite anticoagulation and antiplatelet therapy.
Implications:
- This case underscores the possibility of spontaneous arterial dissection in childhood.
- Aneurysm formation is a recognized complication, more common after cervical than cerebral artery dissection.
- Highlights the importance of considering dissection in pediatric stroke evaluations.
Background:
Dissection of the walls of the cervical and cerebral arteries is rare in childhood.
Case Report:
A 6 year-old girl suddenly suffered a loss of consciousness followed by a generalized tonic-clonic seizure 90 min after a non-traumatic fall. At admission, she had a massive right hemiplegia with aphasia. The CSF was not hemorrhagic. A CT-scan performed at H3 without infusion of radiopaque contrast material was normal, but a second CT-scan on day 4 showed a low density in the low area of the middle cerebral artery. An arteriogram taken on day 6 showed that the wall of the proximal part of this artery was irregular, with a discrete additive imaging. The child was treated with IV heparin for 3 weeks, then with aspirin. All investigations for the possible cause of thrombosis (protein C and S, antithrombin III, homocystinuria, etc...) were negative. Two further arteriograms, the last after a follow-up of 16 months, showed progressive disappearance of the wall irregularities and replacement of the additive imaging by a large aneurysm, suggesting a dissection. The hemiplegia persists under prolonged aspirin therapy.
Conclusion:
This case shows that dissection may occur in childhood without any apparent cause. It can result in the development of an aneurysm, a complication which is more frequent following dissection of the cervical rather the cerebral arteries.