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NEUROLOGY 2009;72:e100
© 2009 American Academy of Neurology
Resident and Fellow Section

Child Neurology: Stroke due to nontraumatic intracranial dissection in a child

Bernhard Suter, MD and Lisa Michael El-Hakam, MD

From the Department of Pediatric Neurology, Texas Children's Hospital, Baylor College of Medicine, Houston.

Address correspondence and reprint requests to Dr. Lisa Michael El-Hakam, Department of Pediatric Neurology, Baylor College of Medicine, Texas Children's Hospital, 6621 Fannin St. CC 1250, Houston, TX 77030-2399 hakam{at}bcm.edu

A 9-year-old girl without prior trauma presented with weakness and headache. Examination showed profound left hemiplegia. MRI demonstrated a right middle cerebral artery (MCA) territory infarction. Magnetic resonance angiography showed proximal right MCA irregularity. Conventional angiography revealed an intracranial dissection (figure).


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  		Figure MRI and catheter angiography

(A, B) Diffusion-weighted sequence of MRI of the brain shows acute infarction in the right middle cerebral artery (MCA) territory. (C, D) Catheter angiography showed irregularities of the right supraclinoid internal carotid artery, extending into the M1 segment of the right MCA. An intimal flap (arrow) indicates dissection.

 

Intracranial dissections are frequently spontaneous (nontraumatic) and are associated with stroke in the young, comprising 60% of anterior circulation dissections in childhood.1 Exclusion of intracranial dissections is challenging using magnetic resonance angiography; cerebral angiography must be considered.2 Potential treatments include anticoagulation and antiplatelet therapies; Class III recommendations discourage anticoagulation because of the association of subarachnoid hemorrhage with intracranial dissection.2

Disclosure: The authors report no disclosures.


   REFERENCES
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  1. Fullerton HJ, Johnston SC, Smith WS. Arterial dissection and stroke in children. Neurology 2001;57:1155–1160.[Abstract/Free Full Text]
  2. Roach ES, Golomb MR, Adams R, et al. Management of stroke in infants and children: a scientific statement from a Special Writing Group of the American Heart Association Stroke Council and the Council on Cardiovascular Disease in the Young. Stroke 2008;39:2644–2691.[Abstract/Free Full Text]




This Article
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Right arrow Articles by Suter, B.
Right arrow Articles by El-Hakam, L. M.
Related Collections
Right arrow Childhood stroke
Right arrow All Cerebrovascular disease/Stroke
Right arrow Carotid artery dissection

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