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Vertebral artery dissection: issues in diagnosis and management
D S Khurana1, C G Bonnemann, E C Dooling
1Department of Neurology, Massachusetts General Hospital, Boston 02114, USA.
Pediatric Neurology
|April 1, 1996
Summary
Vertebral artery dissection is a rare cause of pediatric stroke. This study suggests magnetic resonance angiography (MRA) can aid diagnosis and anticoagulation may prevent further strokes in children.
Area of Science:
- Neurology
- Pediatric Neurology
- Vascular Neurology
Background:
- Vertebral artery dissection (VAD) is an infrequent cause of stroke in pediatric populations.
- Diagnostic accuracy of magnetic resonance angiography (MRA) versus transfemoral angiography (TFA) for VAD remains debated.
- The optimal anticoagulation strategy for pediatric VAD is not well-established.
Observation:
- Two pediatric cases of VAD are presented, one with hemiparesis and seizures, the other with ataxia.
- Initial MRA scans were inconclusive for VAD, despite evidence of posterior circulation infarcts on other imaging.
- Subsequent MRA revealed suspected VAD, confirmed by TFA, leading to anticoagulation therapy.
Findings:
- One patient experienced new infarcts despite initial aspirin therapy, later requiring combined warfarin and aspirin.
- The second patient, after 6 months of heparin and warfarin, is managed with aspirin alone.
- These cases highlight the potential utility of MRA in diagnosing VAD with a high index of suspicion.
Implications:
- Early and accurate diagnosis of pediatric VAD may be achievable with MRA, reducing the need for invasive procedures.
- Anticoagulation therapy appears beneficial in preventing recurrent ischemic events in pediatric VAD.
- Further research is warranted to establish definitive treatment guidelines for pediatric vertebral artery dissection.