Arterial dissection and stroke in children

Objective: To describe the clinical characteristics of dissections of cereb ral arteries in children. Methods: Searches of MEDLINE (1966-2000) and bibl iographies were systematically performed for English-language publications that described patients < 18 years old with anterior circulation arterial d issections (ACAD) or posterior circulation arterial dissections (PCAD). Res ults: 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 tra uma were excluded, this male predominance persisted. All patients had evide nce of cerebral ischemia at the time of diagnosis. Headache was reported in approximately half of patients. Sixty percent of ACAD were intracranial. A CAD with no preceding trauma were more commonly intracranial than those pre ceded by significant trauma (86 vs 25%, p = 0.002). The most common locatio n for PCAD was the vertebral artery at the level of the C1-C2 vertebral bod ies (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 1 0% of the ACAD group had recurrent dissections. Conclusions: There is a mar ked male predominance among children with cerebral arterial dissections tha t is not explained by trauma. Unlike adult ACAD, childhood ACAD are most co mmonly intracranial. Spontaneous ACAD, in particular, tend to be intracrani al, while post-traumatic ACAD are more often extracranial. The vertebral ar tery segment most susceptible to dissection is similar between children and adults.