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Craniocervical Arterial Dissection in Children: Clinical and Radiographic Presentation and Outcome

Division of Neurology

Derek Armstrong, MD

Division of Neurology, Department of Pediatrics, Division of Neuroradiology

Gabrielle deVeber, MD, MSc

Division of Neurology, Department of Diagnostic Imaging, and Population Health Sciences Program

Trish Domi, MSc

Division of Neurology

Anthony Chan, MD

The Hospital for Sick Children, Toronto, ON, Canada

Daune L. MacGregor, MD

Division of Neurology daune. macgregor{at}sickkids.ca.

Craniocervical arterial dissection is a recognized cause of arterial ischemic stroke in children. Whether children with craniocervical arterial dissection have dissection characteristics different from those of adults is unclear. A retrospective review of children, 1 month to 18 years of age, with dissection from two Canadian pediatric ischemic stroke registry centers was conducted. From 213 patients with arterial ischemic stroke, 16 (7.5%) were identified with dissection, 37.5% had warning symptoms, and 50% had a history of head or neck trauma. The clinical presentation included headache (44%), altered consciousness (25%), seizures (12.5%), and focal deficits (87.5%). Dissection involved extracranial vessels in 75% and anterior circulation in 56%. Follow-up included complete recovery in 43%, mild to moderate deficits in 44%, and severe deficits in 13%. Fourteen (87.5%) children received antithrombotic treatment. Follow-up angiography showed resolution of abnormalities in 60% of vessels. Total occlusion had the worst outcome for recanalization. In conclusion, the etiology of arterial dissection in the majority of children appears to be either trauma or idiopathic. Long-term angiography shows variable outcomes, depending on the initial findings. The relationship of angiographic outcomes with recurrent strokes requires further study in pediatric dissection. ( J Child Neurol 2006;21:8—16).

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