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Regressing intracranial carotid occlusions in childhood
Insights
Intracranial carotid artery dissection, though rare in children, can cause stroke. Fortunately, these dissections often heal on their own, leading to good long-term outcomes.
Area of Science:
- Neurology
- Pediatric Neurology
- Vascular Neurology
Background:
- Intracranial carotid artery dissection (ICAD) is uncommon in children.
- ICAD can lead to significant neurological deficits, including stroke.
Observation:
- Three healthy children (8, 12, 15 years) presented with headache and stroke due to ICAD.
- Two cases were linked to strenuous physical activity.
- Angiography showed varied patterns, including stenosis, Moya Moya network, and "string sign," with anterior cerebral artery occlusion consistently present.
Findings:
- Follow-up angiography demonstrated spontaneous recanalization in all cases, indicating a self-healing process.
- All patients experienced a favorable clinical course with good neurological recovery at long-term follow-up (2-5 years).
Implications:
- ICAD may have benign forms with potential for spontaneous resolution, similar to extracranial dissections.
- The possibility of self-healing dissection suggests conservative management should be considered against surgical intervention.
Abstract:
Though detected with increasing frequency, intracranial carotid artery dissection remains less common in infancy. We report on 3 otherwise healthy children aged 8, 12 and 15 years who presented with focal headache and stroke secondary to intracranial carotid occlusive disease consistent with arterial dissection. In 2 cases this was precipitated by strenuous physical exertion. The protean angiographic configuration included long tapered narrowing with focal stenosis, beaded narrowing with Moya Moya vascular network and 'string sign'; occlusion of the anterior cerebral artery was always present. Control angiograms revealed complete or partial recanalization in all cases suggesting self-healing dissection. The clinical course was smooth in all patients, and at long-term follow-up (5, 3, and 2 years) they remain in good neurological condition. Although intracranial carotid dissection has a poor reputation, regression to normal and fair outcome may sometimes occur as in the extracranial counterpart, suggesting the existence of benign forms of the disease. Surgical procedures should be weighed against the spontaneous resolution of the lesion.