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Bilateral obstruction of the vertebral arteries in a three-year-old child
Insights
A three-year-old boy experienced vertebrobasilar obstruction, leading to neurological symptoms. Prompt diagnosis and recognition of collateral circulation facilitated a full recovery, highlighting the importance of obstruction site in childhood cases.
Area of Science:
- Neurology
- Vascular Medicine
- Pediatrics
Background:
- Vertebrobasilar artery obstruction is rare in children.
- Early diagnosis and intervention are crucial for favorable outcomes.
Observation:
- A 3-year-old boy presented with gait instability, nausea, vomiting, cranial nerve deficits, hypotonia, and dysarthria.
- Cranial angiography revealed complete obstruction of both vertebral arteries at C1-C2.
- Hypoplastic left vertebral artery and bilateral internal carotid artery coiling were noted. Elevated erythrocyte sedimentation rate suggested inflammatory changes.
Findings:
- Abundant collateral circulation successfully bypassed the vertebral artery obstructions.
- The patient experienced a complete neurological recovery within one month.
- The location of arterial obstruction significantly influences clinical presentation and prognosis in pediatric vertebrobasilar cases.
Implications:
- This case underscores the importance of considering vascular etiologies in pediatric neurological deficits.
- Understanding collateral pathways is vital for managing vertebrobasilar obstructions.
- Further research into the inflammatory aspects of dysplastic vertebral arteries in children is warranted.
Abstract:
A three-year-old boy developed gait instability, nausea, vomiting, cranial nerve disturbances, hypotonus and dysarthria. Angiography of the four main cranial arteries showed complete obstruction of both vertebral arteries at the level of C1 to C2. Abundant collateral circulation was observed, which by-passed the obstruction to the vertebral arteries before their enterance into the posterior cranial fossa. The left vertebral artery was hypoplastic and both internal carotid arteries showed coiling in their extracranial portions. A high erythrocyte sedimentation rate at the beginning of the disease suggests an inflammatory alteration of both dysplastic vertebral arteries. The child recovered completely one month after the onset of symptoms. All other reported cases of childhood vertebro-basilar obstruction are reviewed and it is emphasized that the site of arterial obstruction has an important bearing on the clinical outcome.