VERTEBRAL ARTERY DISSECTION - ISSUES IN DIAGNOSIS AND MANAGEMENT

Vertebral artery dissection is an uncommon cause of stroke in children , Accuracy of diagnosis by magnetic resonance angiography (MRA) instea d of invasive transfemoral angiography (TFA) has been controversial, T he need for anticoagulation and duration of such therapy is also argua ble, We report 2 boys with vertebral artery dissection: one, aged 7 ye ars, presented with hemiparesis and seizures and the other, aged 4 yea rs,presented with ataxia. Each boy's initial MRA was not interpreted a s delineating occlusive lesions to explain the posterior circulation i nfarcts visualized on computed tomography and magnetic resonance imagi ng scans, However, subsequent MRAs were suspicious for vertebral arter y dissection, which was confirmed by TFA, Both children were treated w ith anticoagulation therapy. The first patient continued to manifest e vidence of new infarcts despite treatment (initially with aspirin alon e, followed by anticoagulation with heparin and warfarin), and is now maintained on a combination of high dose warfarin and aspirin, The sec ond patient is now maintained on aspirin alone after initial anticoagu lation for 6 months with heparin followed by warfarin, A high index of suspicion for vertebral artery dissection may allow diagnosis on the basis of MRA alone, Previous reports have indicated good outcomes of v ertebral artery dissection in children and adults irrespective of anti coagulation treatment, Our experience suggests that anticoagulation ma y be beneficial in preventing further strokes caused by the dissection .