A rare cause of ischemic stroke in childhood: spontaneous long segment intracranial dissection
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CASE REPORT
A rare cause of ischemic stroke in childhood: spontaneous long segment intracranial dissection Erdem Simsek 1 & Sanem Yilmaz 1
&
Ismail Oran 2 & Gul Aktan 1 & Hasan Tekgul 1 & Sarenur Gokben 1
Received: 14 November 2019 / Accepted: 31 January 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Craniocervical arterial dissection is an important cause of arterial ischemic stroke in children. Recognition of dissections is of particular importance both in determining the risk of recurrence and in bringing about different treatment alternatives. We report a 10-year-old girl who presented with acute ischemic stroke due to spontaneous long segment dissection involving the parasellar internal carotid artery up to the distal M1 portion of the middle cerebral artery. Three-dimensional digital subtraction angiography with flat panel detector revealed the presence of major vessels originating from both true and false lumens and had a critical role in the treatment decision of the case. Keywords Dissection . Intracranial . Pediatric . Spontaneous . Stroke
Introduction
Case report
Ischemic stroke is an important cause of neurological morbidity in childhood. Arteriopathy is the most important risk factor for childhood stroke [1, 2]. Dissection among the causes of non-inflammatory arteriopathy is responsible for approximately 7.5–20% of ischemic stroke, but being entirely dependent on used imaging modalities, it is estimated to be more frequent than expected [1–4]. The recognition of dissections is important because of the recurrence rate of up to 20% and the possible need for different treatment approaches [1, 5]. Here, we present a case with a long segment spontaneous intracranial dissection. To the best of our knowledge, this is the longest spontaneous intracranial dissection in the pediatric age group reported up to date. Another interesting aspect of this case is the lack of any improvement of dissection in the control imaging after 2 years.
A 10-year-old girl was admitted to the emergency department with headache and right-sided weakness. No prior history of trauma was reported. Physical examination revealed right hemiplegia, right central facial palsy, and expressive aphasia. Magnetic resonance imaging was consistent with acute ischemia in the posterior segment of the basal ganglia and the corona radiata on the left side (Fig. 1). Any finding suggestive for arteriopathy was not detected by carotid Doppler ultrasonography. Low-molecular-weight heparin therapy was initiated. Genetic panel study for predisposition to thrombosis was found normal. Magnetic resonance angiography (MRA) revealed an intraluminal dissection flap starting from the terminal segment of the left internal carotid artery (ICA) extending to the bifurcation of the left middle cerebral artery (MCA) (Fig. 2). When evaluated for endovascular intervention with three-dimensional digital subtraction angiography (DSA) with flat panel detector computed tomography, a long intimal dissection flap extending from the parasella
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