Spontaneous Carotid Artery Dissection – A Case Study in Pediatric Aged

Background: Craniocervical arterial dissection is rarely recognized in children and usually presents with symptoms of acute ischemic stroke (AIS) or transient ischemic attack. Most cases result from trauma to the oropharynx or neck, but spontaneous dissections have been reported in a variety of systemic conditions (such as connective tissue disorders). In the absence of systemic disease or antecedent trauma, arterial dissection appears to be rare in younger children.

Objective: We present a case report of a child with AIS due to spontaneous carotid artery dissection (CAD).

Methods - Case Report: A healthy five-year-old male, without antecedent illness or history of obvious trauma, presented with holo-cranial headaches, deviation of the right labial commissure, and left hemiparesis twelve hours before admission to the hospital. At admission, computed tomography (CT) was normal, but magnetic resonance imaging (MRI) revealed recent stroke in the cortical region and deep distribution within the right middle cerebral artery. The child was initially treated with subcutaneous low weight heparin and oral acetylsalicylate acid. On the third day, he presented with a severe headache, including vomiting. Repeated CT revealed an increase of intralesional edema in the areas of subacute infarction without hemorrhagic transformation. On the fifth day, neck vessels Doppler ultrasound revealed signs of right internal CAD. After diagnosis of CAD, the patient started therapy with warfarin. During hospitalization, there was improvement in loss-of-strength and regression of the deviation of the labial commissure. There were no additional symptoms, and the patient was discharged after thirteen days of hospitalization. In follow-up control neck and head Angio CT showed total resolution of CAD.

Conclusion: Spontaneous CAD is a potential cause of transient neurological symptoms and AIS and must be considered as an etiology of childhood strokes, especially when symptoms include headache or cervical pain. However, appropriate clinical judgment should be exercised.