Cerebellar Infarction from a Traumatic Vertebral Artery Dissection in a Child

Abstract

Infarction due to vertebral dissection is a rarely reported event in children. We describe the clinical presentation, radiological findings and surgical treatment of a child with cerebellar infarction resulting from a traumatic vertebral artery dissection. Review of the literature on stroke due to a vertebral artery dissection in the pediatric population shows that trauma is a common preceding event. Although the most common site of traumatic vertebral artery dissection is at C1–2 level, our case illustrates that the vertebral artery dissection may also involve the lower cervical segment. We emphasize that vertebral artery dissection should be considered in a child with acute symptoms and signs of posterior circulation ischemia and that MRI and MR angiography may be helpful in the diagnosis of infarction and vertebral artery dissection.

Vertebral Artery Dissection in Children: A Comprehensive Review

“…Although the prevalence of stroke in children due to lesions in the vertebrobasilar system is low [2], the recent surge of cases reported in children [6, 7, 8, 9, 10, 11, 12]suggests that the true incidence of this clinical entity has been underestimated. The number of cases of VAD identified in children between 1952 and 1990 was 32, and between 1991 and 2001, it was 36.…”

“…Craniotomy for posterior fossa decompression was performed in 3 [2, 29, 55]. Two patients underwent vascular reconstruction [18, 43].…”

“…Ouvrier and Hopkins [1]first reported angiographically confirmed vertebral artery dissection (VAD) in two children (aged 4 and 9) in 1970. In 1997, Kim et al [2]and Tabarki et al [3]reported findings of VAD in 25 and 24 children, respectively. Many of the patients selected were similar in these two reports.…”

Traumatic Vertebral Artery Dissection in a Child with Brachial Plexus Injury

“…Giacobetti et al [2] reported flexion/distraction-type injuries to be the most common mechanism in nonpenetrating vertebral artery injuries, followed by flexion compression mechanism. The most common TVAD lesion is at the C 1–2 level, as in our case, because rotation of head occurs at the atlantoaxial joint [1, 6]. The authors hypothesize that after the large impact of the left temporal area of the head with deep laceration on scalp, the boy’s neck was suddenly and laterally bent to the right side, resulting in the dissection of the ipsilateral left vertebral artery.…”

“…Ouvrier and Hopkins [9] first reported angiographically confirmed TVAD in two children in 1970. The overall incidence of stroke in children has been estimated at about 2.5 per 100,000 and stroke after TVAD is rarely reported [3, 6, 7, 13]; however, TVAD is an important cause of brain stem stroke in children.…”