Late Complications of Vertebral Artery Dissection in Children: Pseudoaneurysm, Thrombosis, and Recurrent Stroke
Division of Neurology, Hospital for Sick Children, Ontario, Canada.Journal of child neurology (Impact Factor: 1.72). 04/2009; 24(3):354-60. DOI: 10.1177/0883073808324775
Craniocervical arterial dissection is an important cause of childhood arterial ischemic stroke, accounting for 7.5% to 20% of cases. Significant neurologic morbidity and mortality may result and recurrence risk may be higher than in adults. However, the natural history and long-term outcome of pediatric dissection are poorly studied. We report 3 cases of extracranial vertebral artery dissection with complications including pseudoaneurysm formation, recurrent stroke, and late spontaneous thrombosis of the dissected artery. These cases illustrate the dynamic processes involved in vascular injury and healing of vertebral artery dissection in children over years, with potential implications for long-term management and prevention of recurrence.
Article: Stroke and cerebrovascular disorders[Show abstract] [Hide abstract]
ABSTRACT: Stroke and cerebrovascular disorders in childhood are a cause for significant morbidity in childhood. There is growing emphasis on understanding the mechanisms of stroke so as to inform developments in investigation and management. Advances have been made in the classification of pediatric stroke, aided by clinical and radiological recognition of patterns of injury and differential outcomes dependent on timing of stroke occurrence. Risk factors are multifactorial, with evidence of geographical and national variation. Causality, however, remains difficult to prove. Recent studies highlight a significant association between stroke recurrence and outcome and the presence of steno-occlusive arterial disease, Moyamoya disease and progressive arteriopathy. Focal arteriopathy of childhood is a new term proposed to refine the nomenclature of childhood arteriopathy. The association between infection and childhood stroke is increasingly recognized, with associations with sinovenous thrombosis and childhood arteriopathy. The recommendation to screen for arteriopathy in genetic conditions such as sickle cell disease is now extended to include children with neurofibromatosis type 1. Perfusion and magnetic resonance wall imaging have helped in the determination of the cause of stroke with impact on management in adults. Two new treatment guidelines have been published (American Heart Association and Chest), but barriers remain to the use of thrombolysis in childhood stroke. Continued developments in understanding and practice in childhood stroke are encouraging. However, the absence of clinical trials and evidence-based guidelines is limiting. The conduct of such trials is a goal towards which the International Pediatric Stroke Study is moving.
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ABSTRACT: Trauma continues to be the leading cause of death in children older than 1 year of age. Although vascular injuries are uncommon, they contribute significantly to the mortality and morbidity related to traumatic injuries in the pediatric age group. In a recently reported large series of children, the head and neck location constituted 19.4% of all pediatric vascular injuries and accounted for most of the mortality observed. Catheter angiography is still considered as the gold standard diagnostic modality. However, because of its invasive nature, other techniques such as computed tomography angiography and magnetic resonance angiography are emerging as alternative diagnostic screening tools. Traumatic vascular injuries can involve the carotid as well as the vertebral arteries. They can be extracranial or intracranial. As a result, traumatic vascular injuries are a heterogeneous group of entities with potential significant implication on the natural history and prognosis. The optimal management of these injuries remains unclear and current practice is largely individualized. This report reviews the available literature regarding the current trends in diagnosis and management of pediatric traumatic vascular injuries.
Article: Pediatric stroke[Show abstract] [Hide abstract]
ABSTRACT: Pediatric stroke, while increasingly recognized among practitioners as a clinically significant, albeit infrequent entity, remains challenging from the viewpoint of clinicians and researchers. Advances in neuroimaging have revealed a higher prevalence of pediatric stroke while also provided a safer method for evaluating the child's nervous system and vasculature. An understanding of pathogenic mechanisms for pediatric stroke requires a division of ages (perinatal and childhood) and a separation of mechanism (ischemic and hemorrhagic). This article presents a review of the current literature with the recommended divisions of age and mechanism. Guidelines for treatment, though limited, are also discussed.
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