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Stroke Recurrence in Children with Vertebral Artery Dissecting Aneurysm
Z Ritchey1, T J Bernard2,3, L Z Fenton4
1From the Department of Radiology (Z.R.), University of Colorado School of Medicine, Aurora, Colorado.
Insights
Pediatric vertebral artery dissecting aneurysms are often missed in initial stroke evaluations. In children with vertebral artery dissection, aneurysms are linked to younger stroke onset and higher recurrence risk.
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.
Background And Purpose:
Pediatric vertebral artery dissecting aneurysm is a subtype of vertebral artery dissection that can be challenging to diagnose and may be associated with stroke recurrence. This study examines the presenting features, clinical outcomes, and recurrence risk in a cohort of children with vertebral artery dissection, comparing those with aneurysms with those without.
Materials And Methods:
The medical records of children evaluated for vertebral artery dissection were retrospectively reviewed for neurologic presentation, treatment, stroke recurrence, and angiographic appearance of dissection. Cohort patients were categorized into 2 groups based on the presence or absence of a vertebral artery dissecting aneurysm and compared via the Fisher exact test, Student t test, and log-rank analyses. P < .05 was deemed statistically significant.
Results:
Thirty-two patients met the inclusion criteria, including 13 with vertebral artery dissecting aneurysms. Five cases of vertebral artery dissecting aneurysm were missed on the initial evaluation and diagnosed retrospectively. All patients received antiplatelet or anticoagulation therapy at the time of diagnosis. Children in the vertebral artery dissecting aneurysm group were more likely to present with stroke (P = .059), present at a younger age (P < .001), and have recurrent stroke (P < .001) compared with the group of children with vertebral artery dissection without an aneurysm. After surgery, no patients with vertebral artery dissecting aneurysm experienced recurrent stroke (P = .02).
Conclusions:
Vertebral artery dissecting aneurysm is often missed on the initial diagnostic evaluation of children presenting with stroke. In children with vertebral artery dissection, the presence of an aneurysm is associated with stroke presentation at a younger age and stroke recurrence.
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