SPONTANEOUS BASILAR ARTERY DISSECTION AS A CAUSE OF STROKE IN YOUNG CHILDREN: REPORT OF TWO CASES

Objectives: Case report.

Conclusion: With the advent of MRA, cervicocerebral dissection is being recognized more frequently as a cause of stroke in children. Most dissections involve the anterior circulation and the majority involve the extracranial arteries. Basilar artery dissection has been reported in only few cases. We report two cases of basilar artery dissection in children under the age of 3 years. In each case the diagnosis was established by the presence of intramural hematoma on MRA. Neither child had significant head or neck trauma. Work up for cardioembolic, vasculitic, prothrombotic, and mitochondrial disorders were normal. One was treated with Aspirin and the other received Low Molecular Weight Heparin. Both made a complete recovery in one week. Case 1: A 3 year old boy presented with acute right hemiparesis. Brain MRI showed two strokes of different ages in the left thalamus extending to the posterior limb of the internal capsule. Intracranial and extracranial MRA showed dissection of the entire left vertebral artery extending to the basilar artery with interruption of both PCAs, left more proximally than right. Case 2: A 14 month old boy presented with acute right hemiplegia. Brain MRI showed acute infarctions in multiple sites involving left thalamus and internal capsule, left occipital lobe, and bilateral cerebellum. Intracranial and extracranial MRA showed dissection of the basilar artery. A small segment of the left vertebral artery, which is not contiguous with the basilar artery dissection, was also suspicious for dissection. Basilar artery dissection should be considered in the differential diagnosis of acute hemiplegia in young children even in the absence of significant trauma. MRA with T1 weighted images is useful in establishing the diagnosis.