Recurrent Stroke in a Child With Atlantoaxial Instability Following Chiropractic Manipulation

Area of Science:

• Neurology
• Pediatrics
• Radiology

Background:

• Pediatric stroke diagnosis requires timely and accurate imaging modalities.
• Concurrent blood work and imaging are crucial for efficient pediatric stroke evaluation.
• Prompt management hinges on rapid symptom-to-intervention timelines.

Observation:

• A challenging case of pediatric bow hunter's stroke is presented.
• This stroke involves vertebral artery occlusion during neck rotation.
• Diagnosis was complicated, necessitating a thorough workup.

Findings:

• Bow hunter's stroke occurs due to vertebral artery occlusion at the atlantoaxial or subaxial levels during neck rotation.
• Comprehensive stroke workup should prioritize mechanical and anatomical possibilities.
• Rarer hypercoagulable disorders should be investigated after excluding mechanical causes.

Implications:

• This case underscores the importance of considering diverse etiologies in pediatric stroke.
• A systematic and broad diagnostic approach is vital for effective pediatric stroke management.
• Early identification of mechanical stroke causes can significantly improve patient outcomes.