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Thalamic infarction in childhood due to extracranial vertebral artery abnormalities
J M Randall1, P D Griffiths, D Gardner-Medwin
1Department of Neuroradiology, Newcastle General Hospital, Newcastle upon Tyne, UK.
Insights
Two children experienced thalamic infarctions due to vertebral artery abnormalities, including dissection and aneurysms. Prompt diagnosis and treatment led to full neurological recovery in both pediatric patients.
Area of Science:
- Neurology
- Pediatric Neurology
- Vascular Neurology
Background:
- Thalamic infarctions are rare in children.
- Vertebro-basilar circulation is crucial for thalamic blood supply.
- Standard angiograms may not always reveal cervical vertebral artery pathologies.
Observation:
- Two pediatric patients presented with thalamic infarctions confirmed by CT scans.
- Initial angiograms appeared normal, but did not fully visualize the extracranial vertebral arteries.
- Subsequent detailed angiograms revealed significant abnormalities in the cervical vertebral arteries.
Findings:
- One child had vertebral artery dissection and pseudoaneurysm.
- The other child presented with a large fusiform aneurysm of the vertebral artery.
- Both cases involved the vertebro-basilar system supplying the thalamus.
Implications:
- Thorough evaluation of the entire vertebral artery, including extracranial segments, is critical in pediatric thalamic infarction cases.
- Cervical vertebral artery abnormalities like dissection and aneurysms should be considered in the differential diagnosis.
- Early identification and management of these vascular lesions can lead to favorable neurological outcomes in children.
Abstract:
We report two children who developed thalamic infarctions which were demonstrated by CT. Both children had apparently normal angiograms although the extra cranial portions of the vertebral arteries were not demonstrated on the initial examination. Subsequent angiograms demonstrated abnormalities of the cervical portion of the vertebral arteries, dissection and pseudoaneurysm in one case and a large fusiform aneurysm in the other. Both children made full neurological recoveries. The thalamus is supplied by branches from the vertebro-basilar circulation and it is important to study the entire length of the extra cranial vertebral arteries as well as the intracranial vasculature.