REGRESSING INTRACRANIAL CAROTID OCCLUSIONS IN CHILDHOOD

Though detected with increasing frequency, intracranial carotid artery dissection remains less common in infancy. We report on 3 otherwise h ealthy children aged 8, 12 and 15 years who presented with focal heada che and stroke secondary to intracranial carotid occlusive disease con sistent with arterial dissection. In 2 cases this was precipitated by strenuous physical exertion. The protean angiographic configuration in cluded long tapered narrowing with focal stenosis, beaded narrowing wi th Moya Moya vascular network and 'string sign'; occlusion of the ante rior cerebral artery was always present. Control angiograms revealed c omplete or partial recanalization in all cases suggesting self-healing dissection. The clinical course was smooth in all patients, and at lo ng-term follow-up (5, 3, and 2 years) they remain in good neurological condition. Although intracranial carotid dissection has a poor reputa tion, regression to normal and fair outcome may sometimes occur as in the extracranial counterpart, suggesting the existence of benign forms of the disease. Surgical procedures should be weighed against the spo ntaneous resolution of the lesion.