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Two illustrative cases of traumatic intracranial cerebral artery dissection in children
Masaaki Hokari1, Daisuke Shimbo1, Kazuki Uchida1
1Department of Neurosurgery, Teine Keijinkai Hospital, Sapporo, Japan.
Insights
Traumatic intracranial cerebral artery dissection (ICAD) is uncommon in children. Prompt intervention for worsening symptoms or imaging in pediatric traumatic ICAD cases can lead to positive outcomes.
Area of Science:
- Neurology
- Pediatric Neurology
- Vascular Neurology
Background:
- Traumatic intracranial cerebral artery dissection (ICAD) is a rare condition in children.
- Pediatric ICAD can result from head or neck trauma.
- Early diagnosis and management are crucial for favorable outcomes.
Observation:
- Two pediatric cases of traumatic ICAD are presented: a 13-year-old boy with middle cerebral artery territory infarction and a 10-year-old boy with basilar artery dissection.
- Both patients experienced traumatic injuries leading to arterial dissection, with one case involving progressive infarction and the other subarachnoid hemorrhage.
Findings:
- The first patient underwent bypass surgery due to deteriorating hemiparesis and infarction, showing significant recovery.
- The second patient's basilar artery dissection and headache gradually resolved without specific intervention, leading to a full neurological recovery.
Implications:
- The management of traumatic ICAD in children requires careful consideration, balancing the risks and benefits of interventions like vascular reconstruction.
- Prompt therapeutic intervention is recommended when clinical symptoms or imaging findings indicate deterioration, potentially preventing long-term disability.
Abstract:
Traumatic intracranial cerebral artery dissection (ICAD) in the pediatric population is relatively rare. We report two traumatic ICAD cases in children. Case 1: A 13-year-old boy presented with headache and left hemiparesis after body contact while playing basketball. We found a cerebral infarction in the middle cerebral artery territory and dissection at the bifurcation of the right internal carotid artery and posterior communicating artery. Six days after onset, his right hemiparesis deteriorated, and the infarction progressed. Therefore, bypass surgery was performed. Three months later, he regained the ability to walk without a cane and resumed school. Case 2: A 10-year-old boy fell while skiing and experienced a severe headache several hours later. Neuroradiological examination revealed a subarachnoid hemorrhage in the basal cistern without aneurysm. Six days after admission, magnetic resonance angiography revealed stenotic changes and an irregularly shaped basilar artery (BA). On day 7, an angiogram confirmed BA dissection. The patient's headache gradually improved, and the irregular shape of the BA normalized 3 weeks later. He was discharged without any neurological deficits. Determining whether vascular reconstruction should be performed is challenging. However, we believe that therapeutic intervention should be performed promptly when symptoms or brain images deteriorate.
