Though a rare cause of stroke in the general population, in almost one quarter of young patients affected by stroke cervical artery dissection (CAD) is the underlying cause. Among these cases “spontaneous” dissections, intended as non-traumatic, represent about 34% of posterior circulation arterial dissection in patients aged less than 18 years. We here describe the case of a seven year-old boy who developed a spontaneous vertebral artery dissection (VAD) leading to occipito-mesial, thalamo-capsular and cerebellar infarction. Once a traumatic origin was excluded, clinical history and laboratory findings were further analysed: fever associated with tonsillitis during the previous week, raised inflammatory indices, a throat culture positive for beta haemolysing Streptococcus group A and high titres of streptococcal antibodies were found. This case suggests that patients with CAD referred as spontaneous deserve extensive analysis. Subjects presenting with a dissection and anunderlying infection are likely to have a hyperinflammatory response (although further experience is needed). In these patients immediate start of antibiotic therapy, treatment with anti-inflammatory drugs and further a lifelong prophylaxis with antibiotics before any invasive procedure are strongly recommended.

Vertebral artery dissection in a child. Is "spontaneous" still an appropriate definition? / S. Bacigaluppi, R. Rusconi, P. Rampini, F. Annoni, M.L.P.F. Zavanone, V.E. Carnelli, S.M. Gaini. - In: NEUROLOGICAL SCIENCES. - ISSN 1590-1874. - 27:5(2006 Nov), pp. 364-368.

Vertebral artery dissection in a child. Is "spontaneous" still an appropriate definition?

S. Bacigaluppi
Primo
;
F. Annoni;M.L.P.F. Zavanone;V.E. Carnelli
Penultimo
;
S.M. Gaini
Ultimo
2006

Abstract

Though a rare cause of stroke in the general population, in almost one quarter of young patients affected by stroke cervical artery dissection (CAD) is the underlying cause. Among these cases “spontaneous” dissections, intended as non-traumatic, represent about 34% of posterior circulation arterial dissection in patients aged less than 18 years. We here describe the case of a seven year-old boy who developed a spontaneous vertebral artery dissection (VAD) leading to occipito-mesial, thalamo-capsular and cerebellar infarction. Once a traumatic origin was excluded, clinical history and laboratory findings were further analysed: fever associated with tonsillitis during the previous week, raised inflammatory indices, a throat culture positive for beta haemolysing Streptococcus group A and high titres of streptococcal antibodies were found. This case suggests that patients with CAD referred as spontaneous deserve extensive analysis. Subjects presenting with a dissection and anunderlying infection are likely to have a hyperinflammatory response (although further experience is needed). In these patients immediate start of antibiotic therapy, treatment with anti-inflammatory drugs and further a lifelong prophylaxis with antibiotics before any invasive procedure are strongly recommended.
Vertebral artery dissection ; Spontaneous ; Non-traumatic ; Infection ; Therapy
Settore MED/27 - Neurochirurgia
Settore MED/18 - Chirurgia Generale
Settore MED/38 - Pediatria Generale e Specialistica
nov-2006
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/28584
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