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Vertebral artery dissection with bilateral hemiparesis
1Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, CA 90048-1869.
Insights
Traumatic vertebral artery dissection in a child caused cerebellar and thalamic infarcts, leading to hemiparesis and ataxia. Posterior circulation injury is a key consideration for pediatric vertebrobasilar insufficiency.
Area of Science:
- Neurology
- Pediatric Neurology
- Vascular Neurology
Background:
- Vertebral artery dissection (VAD) is a rare but serious condition.
- While more common in adults, VAD can occur in children following trauma.
- Posterior circulation stroke in children necessitates thorough etiological investigation.
Observation:
- A 5-year-old child presented with acute onset hemiparesis and ataxia.
- Clinical presentation suggested vertebrobasilar insufficiency.
- Cerebral magnetic resonance imaging and angiography confirmed right vertebral artery dissection.
Findings:
- The vertebral artery dissection resulted in cerebellar and thalamic infarcts.
- An arterial thrombus with subsequent embolization was identified as the cause.
- The child's neurological deficits were attributed to these ischemic events.
Implications:
- Traumatic vertebral artery dissection should be considered in pediatric cases of posterior circulation stroke.
- Prompt diagnosis and management are crucial for improving outcomes in pediatric VAD.
- This case highlights the importance of evaluating traumatic vascular injuries in the pediatric population.
Abstract:
Right vertebral artery dissection after trauma, with subsequent cerebellar and thalamic infarcts, is described in a 5-year-old child who presented with mild hemiparesis and ataxia. This vascular injury has been more commonly reported in adults. The diagnosis was confirmed with magnetic resonance imaging of the brain and cerebral magnetic resonance angiography. An arterial thrombus with multiple embolization was the cause of the child's neurologic deficits. Traumatic injury to the posterior circulation should be considered in children who have signs of vertebrobasilar insufficiency.