Spontaneous carotid and vertebral artery dissection in children

Carotid and vertebral artery dissection is a rarely reported cause of strok e in childhood and adolescence, especially if there is not a direct trauma to the neck. Four patients, under 15 years of age, presented with an intern al carotid artery dissection, and one patient presented with a vertebral ar tery dissection. They were all making a physical effort when the event occu rred. The five patients had ischemic symptoms, and in two the events were p receded by transient ischemic attacks. Headache was associated in four pati ents. The diagnosis was made by magnetic resonance imaging and angiography, which included transfemoral angiography in two patients. All improved befo re leaving the hospital, and four patients did not suffer recurrent episode s. The diagnostic accuracy of artery dissection has improved because of non invasive neuroimaging testing, but it should still be suspected in any pedi atric ischemic stroke, especially if there is headache or cervical pain ass ociated. (C) 2001 by Elsevier Science Inc. All rights reserved.