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Spontaneous extracranial carotid artery dissection in children
1Department of Neurology, Indiana University School of Medicine, Indianapolis, USA.
Insights
Cerebral artery dissection is an underrecognized cause of childhood stroke. Increased awareness and advanced imaging can improve diagnosis and outcomes for pediatric stroke patients.
Area of Science:
- Neurology
- Pediatrics
- Vascular Medicine
Background:
- Cerebral artery dissection is a rare but serious cause of stroke, particularly in children.
- Diagnosis is often delayed due to a lack of apparent trauma history.
Observation:
- Two pediatric cases of stroke secondary to extracranial carotid artery dissection are presented.
- A 7-year-old girl experienced chorea and basal ganglia infarct; a 15-year-old boy developed aphasia, hemiparesis, and a middle cerebral artery infarct, ultimately succumbing to cerebral herniation.
Findings:
- Stroke due to arterial dissection may be more common in children than previously thought.
- The absence of a clear trauma history can mask this diagnosis in pediatric stroke cases.
Implications:
- Cerebral artery dissection should be considered in the differential diagnosis of childhood stroke.
- Enhanced awareness and utilization of noninvasive imaging like magnetic resonance angiography can improve diagnostic accuracy and patient prognosis.
Abstract:
Dissection of cerebral arteries as a cause of stroke is rarely recognized in children. Two patients with stroke due to extracranial carotid artery dissection are reported. A 7-year-old girl with a 2-week history of right arm chorea had a left basal ganglia infarct and is receiving haloperidol for persistent chorea. The second patient, a 15-year-old boy, developed aphasia and right hemiparesis a day before admission during a football game without obvious trauma. He had a large left middle cerebral artery infarct and died of cerebral edema and herniation. We believe that strokes due to arterial dissection are more common than currently recognized, partly because of a lack of history of trauma, and suggest that cerebral artery dissection be considered as an etiology of childhood strokes. Greater awareness of arterial dissection as a cause of stroke and availability of noninvasive techniques like magnetic resonance angiography should result in a more accurate diagnosis and improved prognosis in these patients.