Arterial dissection and stroke in children

Objective: To describe the clinical characteristics of dissections of cerebral arteries in children. Methods: Searches of MEDLINE (1966–2000) and bibliographies were systematically performed for English-language publications that described patients <18 years old with anterior circulation arterial dissections (ACAD) or posterior circulation arterial dissections (PCAD). Results: A total of 2,027 studies were reviewed; 118 patients were identified in 79 studies. Seventy-four percent of patients with ACAD (n = 73) and 87% with PCAD (n = 47) were male (p < 0.0001). When patients with preceding trauma were excluded, this male predominance persisted. All patients had evidence of cerebral ischemia at the time of diagnosis. Headache was reported in approximately half of patients. Sixty percent of ACAD were intracranial. ACAD with no preceding trauma were more commonly intracranial than those preceded by significant trauma (86 vs 25%, p = 0.002). The most common location for PCAD was the vertebral artery at the level of the C1–C2 vertebral bodies (53%). Recurrent ischemic events after the diagnosis of dissection were reported in 15% of PCAD and 5% of ACAD cases. None of the PCAD group and 10% of the ACAD group had recurrent dissections. Conclusions: There is a marked male predominance among children with cerebral arterial dissections that is not explained by trauma. Unlike adult ACAD, childhood ACAD are most commonly intracranial. Spontaneous ACAD, in particular, tend to be intracranial, while post-traumatic ACAD are more often extracranial. The vertebral artery segment most susceptible to dissection is similar between children and adults.