Dynamic imaging of the craniovertebral junction is mandatory in patients with posterior circulation strokes

Vupputuri, Hemanth; Gandham, Edmond Jonathan; Mani, Sunithi; Raju, Krishna Prabhu; Aaron, Sanjith; Chacko, Ari G

doi:10.1007/s00586-020-06337-3

Cited by 1 publication

(16 citation statements)

References 20 publications

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“…CVJ anomalies were the cause of stroke in the combined paediatric and adult population in 30% of cases presenting with PCAIS before 50 years of age; above 50 years of age, it dropped to 1.5%. 6 Our study found that 6 out of 14 cases were due to CVJ anomalies, which is much higher than reported. This discrepancy could be due to under-evaluation as pointed out by Phillips et al, 7 since only 30% of published cases reported cervical spine radiographic data and only 11% indicated flexion-extension views.…”

Section: Discussioncontrasting

confidence: 57%

“…11 Dynamic injury to the vertebral artery due to instability causes intimal stress and thrombogenesis resulting in posterior circulation stroke due to dissection or release of emboli into the distal vessels. 6 Ten males, like patients 4 and 5 in our series, were described with recurrent stroke syndrome due to rotational vertebral arteriopathy; two had bony pathology while eight had dynamic compression with head rotation on digital subtraction angiography. 9 These children had recurrent stroke on antiplatelet agents similar to our patients.…”

Section: Discussionmentioning

confidence: 62%

“…Anatomical studies have shown kinking and stretching of the contralateral vertebral artery at greater than 30‐degree rotation and angulation and occlusion of the ipsilateral vertebral artery at greater than 45‐degree rotation at the atlantoaxial joint 11 . Dynamic injury to the vertebral artery due to instability causes intimal stress and thrombogenesis resulting in posterior circulation stroke due to dissection or release of emboli into the distal vessels 6 . Ten males, like patients 4 and 5 in our series, were described with recurrent stroke syndrome due to rotational vertebral arteriopathy; two had bony pathology while eight had dynamic compression with head rotation on digital subtraction angiography 9 .…”

Section: Discussionmentioning

confidence: 99%

“…6 In the absence of abnormality on x-ray and neutral position vascular imaging, a dynamic rotational contrast CT angiogram or magnetic resonance angiogram in the acute period may be worthwhile given the recurrent risk of stroke in these children despite antiplatelet treatment. 6 In patients with vertebral artery dissection, we recommend provocative angiography after 3 to 6 months to allow for healing if the diagnosis is still in doubt. 14 In our series, two patients had recurrent stroke before the final diagnosis and surgical intervention, similar to 3 out of 4 and 8 out of 10 cases reported by Vupputuri et al 6 and Fox et al 9 respectively (Figure 4).…”

Section: Discussionmentioning

confidence: 99%

“…They advised a neck flexion‐extension x‐ray for all and further evaluation if atlantoaxial instability was identified 6 . In the absence of abnormality on x‐ray and neutral position vascular imaging, a dynamic rotational contrast CT angiogram or magnetic resonance angiogram in the acute period may be worthwhile given the recurrent risk of stroke in these children despite antiplatelet treatment 6 . In patients with vertebral artery dissection, we recommend provocative angiography after 3 to 6 months to allow for healing if the diagnosis is still in doubt 14 .…”

Section: Discussionmentioning

confidence: 99%

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Cryptogenic posterior circulation stroke in children

Aripirala

Reddy

Lingappa

et al. 2022

Develop Med Child Neuro

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Posterior circulation arterial ischaemic stroke (PCAIS) in the paediatric age group accounts for 8% to 37% of arterial ischaemic stroke in children. [1][2][3][4] Cervicocephalic arterial dissections are the most common aetiological factors for PCAIS, as opposed to intracranial vasculopathies and cardioembolic factors in anterior circulation stroke in children. 1 Besides head and neck trauma, craniovertebral junction (CVJ) abnormalities are another cause of PCAIS in childhood. Although there are case series describing the aetiological and risk factor profile of PCAIS, CVJ anomalies have rarely been reported. 2-4 Furthermore, there is a significant delay between PCAIS presentation and CVJ anomaly diagnosis ranging from 1 month to 13 years; the recurrence risk is also high for this group of children with PCAIS. 1,5 Although described rarely in literature, the prevalence of CVJ anomalies may be higher in paediatric posterior circulation stroke. In this study, we describe six children presenting with PCAIS due to CVJ anomalies over 3 years and review the literature on the incidence of CVJ anomalies in PCAIS and diagnostic and surgical challenges in these children. M ET HODThe case files of children admitted to a tertiary care paediatric centre between July 2017 and December 2020 with evidence of stroke on imaging were retrieved and analysed retrospectively. Children with PCAIS attributed to CVJ anomaly were included, whereas haemorrhagic stroke and

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Section: Discussioncontrasting

confidence: 57%