Stroke Recurrence in Children with Vertebral Artery Dissecting Aneurysm

Area of Science:

• Neurology
• Pediatric Neurology
• Vascular Neurology

Background:

• Pediatric vertebral artery dissecting aneurysm is a challenging subtype of vertebral artery dissection.
• It is associated with an increased risk of stroke recurrence in children.

Purpose of the Study:

• To examine the clinical features, outcomes, and recurrence risk of pediatric vertebral artery dissection.
• To compare outcomes between children with and without vertebral artery dissecting aneurysms.

Main Methods:

• Retrospective review of medical records for 32 pediatric patients with vertebral artery dissection.
• Categorization into groups based on the presence or absence of a dissecting aneurysm.
• Statistical comparison using Fisher exact test, Student t test, and log-rank analyses.

Main Results:

• 13 of 32 patients had vertebral artery dissecting aneurysms; 5 were initially missed.
• Aneurysm group presented with stroke more often (P=.059), at a younger age (P<.001), and had higher stroke recurrence (P<.001).
• No recurrent strokes were observed post-surgery in the aneurysm group (P=.02).

Conclusions:

• Vertebral artery dissecting aneurysms in children are frequently missed during initial stroke evaluations.
• The presence of an aneurysm in pediatric vertebral artery dissection correlates with younger age at stroke onset and increased recurrence risk.