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Intracranial dissection mimicking transient cerebral arteriopathy in childhood arterial ischemic stroke

Nomazulu Dlamini1, Jeremy L Freeman, Mark T Mackay

  • 1Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada.

Journal of Child Neurology
|July 12, 2011
PubMed

Insights

Misdiagnosing childhood stroke as transient cerebral arteriopathy can be fatal. Intracranial carotid artery dissection requires advanced imaging for accurate diagnosis and timely treatment to prevent severe outcomes.

Area of Science:

  • Neurology
  • Pediatric Stroke
  • Vascular Imaging

Background:

  • Transient cerebral arteriopathy is a common cause of pediatric arterial ischemic stroke.
  • Distinguishing it from intracranial carotid artery dissection is critical for appropriate management.

Purpose of the Study:

  • To report cases of intracranial carotid artery dissection misdiagnosed as transient cerebral arteriopathy.
  • To highlight the limitations of standard imaging in differentiating these conditions.

Main Methods:

  • Retrospective case series from the International Pediatric Stroke Study.
  • Review of clinical presentations, imaging findings (including MRI/MRA), and outcomes.
  • Postmortem examination and dedicated MR wall imaging in select cases.

Main Results:

  • Four pediatric cases of intracranial carotid artery dissection were initially misdiagnosed as transient cerebral arteriopathy.
  • Standard MRA was insufficient to detect dissection, showing only stenosis/occlusion.
  • Three patients died due to refractory intracranial hypertension; dissection was confirmed postmortem in these cases.

Conclusions:

  • Routine MRA is unreliable for differentiating transient cerebral arteriopathy from intracranial carotid artery dissection in children.
  • Advanced imaging modalities such as conventional angiography, gadolinium-enhanced MRA, or dedicated MR wall imaging are essential.
  • Accurate diagnosis is crucial for appropriate treatment and improved outcomes in pediatric stroke.

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