ISQUEMIC STROKE SECONDARY TO ARTERIAL DISSECTION

Objectives: Present a series of stroke cases secondary to arterial dissection.

Methods: Seven patients suffering a stroke, between 5 and 18 years of age, 2 girls and 5 boys presenting carotid artery dissection as the cause in 6, and vertebral artery dissection as the cause in the seventh are presented. In 4 cases a well defined history of trauma was identified, another two patients were practicing sports, no prior factor was identified in the seventh. Only one case showed angiographic images compatible with arterial wall fibrodysplasia. In 5 cases the dissection occurred on the cervical segment of the internal carotid artery, with extension to the intracraneal infraclinoid segment in one case; the petrous segment of the internal carotid was affected only in one of the cases, and the right vertebral artery in another. Clinical signs observed included intense headaches in all patients. Only one presented with Horner's syndrome, one with dyscalculia, 4 had hemiparesis and in the case of vertebral artery dissection, tremor and unilateral dissymmetry were present.

Results: Digital angiograms were performed on all cases to confirm the dissection diagnosis. All patients with one exception were given anticoagulation therapy. One patient presented a vessel aneurism both at pre and post stenotic level requiring surgical repair, the remainder reopened spontaneously after varying time periods.

Conclusion: Spontaneous carotid artery dissection or of the vertebral arteries is the most common cause of stroke in the younger patient. Early diagnosis is key to avoid further thromboembolic events.