Craniocervical Arterial Dissection in Children: Pathophysiology and Management

Area of Science:

• Pediatric Neurology
• Vascular Imaging
• Neuroradiology

Background:

• Craniocervical arterial dissection is a significant cause of stroke in children.
• This condition is associated with high rates of stroke recurrence and varied patient outcomes.
• Understanding its pathophysiology, clinical signs, and imaging is crucial for diagnosis and management.

Purpose of the Study:

• To review the pathophysiology, clinical presentation, and diagnostic neuroimaging of pediatric craniocervical arterial dissection.
• To analyze presenting features, mechanisms, and imaging characteristics from existing literature.
• To guide accurate diagnosis and follow-up strategies for affected children.

Main Methods:

• Conducted MEDLINE searches from 2000 to 2018 for pediatric craniocervical arterial dissection cases.
• Analyzed 16 articles reporting 182 cases in patients under 18 years old.
• Focused on presenting features, pathophysiological mechanisms, imaging characteristics, and interventions.

Main Results:

• Dissection occurred in 182 children (68% male, average age 8.6 years), often linked to trauma (56%).
• Posterior circulation (61%) and extracranial arteries (64%), particularly the vertebral artery (60%), were most involved.
• Hemiparesis (50%) and headache (39%) were common presentations; MRI was the preferred imaging modality.

Conclusions:

• Accurate diagnosis of arterial dissection requires high clinical suspicion and detailed neurovascular imaging of cranial and cervical regions.
• Challenges in visualizing arterial abnormalities emphasize the need for appropriate neuroimaging techniques.
• Magnetic resonance imaging is the preferred modality for pediatric arterial dissection, potentially replacing invasive cerebral catheter angiography.