Recurrent vertebrobasilar embolism in an infant with Klippel-Feil anomaly

Area of Science:

• Neurology
• Pediatric Neurology
• Vascular Neurology

Background:

• Recurrent embolic events obstructing the posterior circulation of the brain in children are hypothesized to originate from the vertebral arteries.
• However, the specific mechanisms of emboli formation in this context remain poorly understood.
• Klippel-Feil anomaly is a congenital condition characterized by fusion of cervical vertebrae, which may be associated with vascular anomalies.

Observation:

• An infant diagnosed with Klippel-Feil anomaly presented with multiple embolic events affecting the posterior circulation of the brain.
• These embolic events were meticulously documented using serial computed tomography (CT) scans and cerebral angiography.
• Cerebral angiography revealed a definitive source of the emboli within the left vertebral artery.

Findings:

• The study identified the left vertebral artery as the source of emboli causing posterior circulation ischemia in an infant with Klippel-Feil anomaly.
• This case provides direct evidence supporting the hypothesis that vertebral arteries can be a source of recurrent emboli in pediatric posterior circulation stroke.
• The findings underscore a potential mechanism for embolic stroke in children with specific congenital anomalies.

Implications:

• Lateral cervical spine radiographs are valuable for screening bony abnormalities that may predispose to vertebral artery anomalies and subsequent embolic events.
• Early identification of vertebral artery anomalies through spinal imaging may allow for timely intervention and prevention of stroke in at-risk pediatric populations.
• This case highlights the importance of considering vertebral artery pathology in the workup of pediatric stroke, particularly in the presence of congenital cervical spine abnormalities.