Related Experiment Video
Updated: Aug 9, 2026
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Craniocervical arterial dissection in children: clinical and radiographic presentation and outcome
Mubeen F Rafay1, Derek Armstrong, Gabrielle Deveber
1Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada.
Insights
Pediatric craniocervical arterial dissection, a cause of stroke, often results from trauma or is idiopathic. Outcomes vary, with complete recovery in 43% and further study needed on angiographic results and recurrent strokes.
Area of Science:
- Pediatric Neurology
- Vascular Neurology
- Pediatric Stroke
Background:
- Craniocervical arterial dissection is a known cause of arterial ischemic stroke in children.
- Characteristics of pediatric craniocervical arterial dissection compared to adults are not well-defined.
Purpose of the Study:
- To investigate the clinical presentation, characteristics, and outcomes of craniocervical arterial dissection in children.
- To compare pediatric dissection features with those typically seen in adults.
Main Methods:
- Retrospective review of pediatric patients (1 month to 18 years) with dissection from two Canadian pediatric ischemic stroke registries.
- Analysis of clinical data, including symptoms, trauma history, affected vessels, and treatment.
Main Results:
- 16 out of 213 (7.5%) pediatric ischemic stroke patients had dissection.
- Common presentations included headache (44%) and focal deficits (87.5%); 50% had head/neck trauma.
- Extracranial vessels were involved in 75%; 43% achieved complete recovery, while 13% had severe deficits.
Conclusions:
- The primary causes of pediatric arterial dissection appear to be trauma or idiopathic.
- Angiographic outcomes are variable and depend on initial findings; total occlusion correlates with poorer recanalization.
- Further research is needed to understand the link between angiographic outcomes and recurrent strokes in pediatric dissection.
Abstract:
Craniocervical arterial dissection is a recognized cause of arterial ischemic stroke in children. Whether children with craniocervical arterial dissection have dissection characteristics different from those of adults is unclear. A retrospective review of children, 1 month to 18 years of age, with dissection from two Canadian pediatric ischemic stroke registry centers was conducted. From 213 patients with arterial ischemic stroke, 16 (7.5%) were identified with dissection, 37.5% had warning symptoms, and 50% had a history of head or neck trauma. The clinical presentation included headache (44%), altered consciousness (25%), seizures (12.5%), and focal deficits (87.5%). Dissection involved extracranial vessels in 75% and anterior circulation in 56%. Follow-up included complete recovery in 43%, mild to moderate deficits in 44%, and severe deficits in 13%. Fourteen (87.5%) children received antithrombotic treatment. Follow-up angiography showed resolution of abnormalities in 60% of vessels. Total occlusion had the worst outcome for recanalization. In conclusion, the etiology of arterial dissection in the majority of children appears to be either trauma or idiopathic. Long-term angiography shows variable outcomes, depending on the initial findings. The relationship of angiographic outcomes with recurrent strokes requires further study in pediatric dissection. (J Child Neurol 2006;21:8-16).
