ARTERIAL DISSECTION AS A CAUSE OF STROKE IN CHILDREN

Objectives: To characterize arterial dissection in ischemic stroke in children and adolescents. Previous retrospective studies have shown a low incidence, a male predominance and the infrequency of neck pain as a presenting complaint.

Methods: Children one month to <18 years of age with acute arterial ischemic strokes were enrolled in a database from 7/2003–9/2005. Gender, dissection location, presenting symptoms, inciting events and stroke risk factors were identified.

Results: Nineteen children, ranging in age from 4 weeks to 15 years, with arterial ischemic stroke were identified during the 27 month interval. 47% were female. Eight children (42%) had MRA, CTA, or conventional angiographic findings consistent with dissection. Three children (ages 6–15 years; one female) had anterior circulation dissections involving the C1-C4, C4 or C1-C2 segments. Symptoms included headache (3), hemiparesis (3), aphasia (1), vomiting (1), change in alertness (1) and possible seizure (1). Two cases were associated with minor head trauma. One child was homozygous for the methylenetetrahydrofolate reductase (MTHFR) mutation. Five children (ages 19 months –11 years; all male) had posterior circulation arterial dissections involving V4 (3), V3 or V1-V4 segments. Symptoms included ataxia/unsteadiness (3), vomiting (3), hemiparesis (2), change in alertness (2) and gaze preference (1). All cases were associated with minor head trauma. Two children were heterozygous for the MTHFR mutation. None of the children with anterior or posterior circulation dissection had neck pain.

Conclusion: Arterial dissection may cause up to 40% of arterial ischemic strokes in children. Males appear to be at higher risk; neck pain is uncommon. The role of secondary stroke risk factors, such as the MTHFR mutation, requires further study.