Cryptogenic posterior circulation stroke in children.
Journal
Developmental medicine and child neurology
ISSN: 1469-8749
Titre abrégé: Dev Med Child Neurol
Pays: England
ID NLM: 0006761
Informations de publication
Date de publication:
06 2023
06 2023
Historique:
revised:
18
10
2022
received:
30
01
2022
accepted:
21
10
2022
medline:
10
5
2023
pubmed:
17
11
2022
entrez:
16
11
2022
Statut:
ppublish
Résumé
We aimed to evaluate the percentage of posterior circulation arterial ischaemic stroke (PCAIS) caused by craniovertebral junction (CVJ) anomalies and describe their clinical course. Children admitted to a tertiary care paediatric hospital with PCAIS between July 2017 and December 2020 were assessed retrospectively for disease aetiology. We reviewed the clinical, radiological, and surgical details of children with evidence of CVJ anomalies. Fourteen (24.1%) of 58 children admitted with arterial ischaemic stroke had posterior circulation involvement. The mean age of patients presenting with posterior circulation stroke was 6 years 6 months (range 3 months-15 years), 11 were male. Six of 14 cases with PCAIS were due to CVJ anomaly, their ages ranged from 4 months to 15 years (two age ranges were noted, 4 months-4 years and 11-15 years), four were male. Two children had atlantoaxial dislocation with basilar invagination, two had Bow Hunter syndrome with Chiari malformation type 1 (one with completed stroke), one had Chiari malformation type 1 alone, and one presented with Farber disease with proatlas segmentation anomaly in CVJ. The time lag to stroke and CVJ diagnosis ranged from 2 weeks to 24 months. A dynamic angiogram was required to evaluate biomechanical changes on scans with inconclusive findings on standard stroke imaging. CVJ anomalies are an important treatable cause of paediatric posterior circulation stroke. Cervical spine x-ray in flexion and extension should be done in all patients with posterior circulation stroke beyond the acute period. In cryptogenic aetiology, provocative angiography with guarded neck rotation should be considered to evaluate possible dynamic vertebral artery compression. WHAT THIS PAPER ADDS: Craniovertebral junction anomalies are an important cause of posterior circulation stroke in children. Evidence of flat occiput, short neck, and short stature in children with posterior circulation stroke should be assessed. Dynamic imaging helps identify dynamic vertebral artery compression.
Types de publication
Review
Case Reports
Langues
eng
Sous-ensembles de citation
IM
Pagination
847-854Informations de copyright
© 2022 Mac Keith Press.
Références
Goeggel Simonetti B, Rafay M, Chung M, Lo W, Beslow L, Billinghurst L et al. Comparative study of posterior and anterior circulation stroke in childhood. Neurology 2019; 94: e337-e344.
Ganesan V, Chong W, Cox T, Chawda S, Prengler M, Kirkham F. Posterior circulation stroke in childhood: Risk factors and recurrence. Neurology 2002; 59: 1552-1556.
Mackay M, Prabhu S, Coleman L. Childhood Posterior Circulation Arterial Ischemic Stroke. Stroke 2010; 41: 2201-2209.
Carey S, Wrogemann J, Booth F, Rafay M. Epidemiology, Clinical Presentation, and Prognosis of Posterior Circulation Ischemic Stroke in Children. Pediatric Neurology 2017; 74: 41-50.
Kulkarni G, Mustare V, Pruthi N, Pendharkar H, Modi S, Kulkarni A. Profile of Patients with Craniovertebral Junction Anomalies with Posterior Circulation Strokes. Journal of Stroke and Cerebrovascular Diseases 2014; 23: 2819-2826.
Vupputuri H, Gandham E, Mani S, Raju K, Aaron S, Chacko A. Dynamic imaging of the craniovertebral junction is mandatory in patients with posterior circulation strokes. European Spine Journal 2020; 29: 1078-1086.
Phillips P, Lorentsen K, Shropshire L, Ahn H. Congenital odontoid aplasia and posterior circulation stroke in childhood. Annals of Neurology 1988; 23: 410-413.
Golomb M, Ducis K, Martinez M. Bow Hunter's Syndrome in Children: A Review of the Literature and Presentation of a New Case in a 12-Year-Old Girl. Journal of Child Neurology 2020; 35: 767-772.
Fox C, Fullerton H, Hetts S, Halbach V, Auguste K, Lawton M et al. Single-center series of boys with recurrent strokes and rotational vertebral arteriopathy. Neurology 2020; 95: e1830-e1834.
Machnowska M, Raybaud C. Imaging of the craniovertebral junction anomalies in children. Advances and Technical Standards in Neurosurgery 2014; 40: 141-170.
Menezes A. Craniocervical developmental anatomy and its implications. Child's Nervous System 2008; 24: 1109-1122.
Pang D. Embryology, Classification, and Surgical Management of Bony Malformations of the Craniovertebral Junction. In: Di Rocco C., Pang D., Rutka J., editors. Textbook of Pediatric Neurosurgery. Springer, Cham; 2017; 1-85.
Shilov G N, Nikitina L I and Schurevich M A. Vertebrobasilar insufficiency caused by Arnold-Chiari syndrome. Neurological Disorders 2018; 6: 83.
Redekop GJ. Extracranial carotid and vertebral artery dissection: a review. Canadian journal of neurological sciences 2008; 35: 146-52.
Menezes AH. Nosographic identification and management of pediatric craniovertebral junction anomalies: evolution of concepts and modalities of treatment. Adv Tech Stand Neurosurg 2014; 40: 3-18.
Menezes AH, Traynelis VC. Anatomy and biomechanics of normal craniovertebral (a) and biomechanics of stabilization (b). Child's Nervous System 2008; 24: 1091-1100.