Multiple Vertebro-Basilar Infarctions from Fibromuscular Dysplasia Related Dissecting Aneurysm of the Vertebral Artery in a Child

Vles, Johan S.H.; Hendriks, J. J. E.; Lodder, J.; Janevski, Blagoja K.

doi:10.1055/s-2008-1071472

Cited by 23 publications

(15 citation statements)

References 10 publications

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“…Seven patients received anticoagulation therapy alone. Recovery was complete in 3 patients [28, 44], whereas the remaining 4 had major or minor neurological deficits [1, 30, 32, 45](table 4). …”

Section: Prognosismentioning

confidence: 99%

“…Three were diagnosed with fibromuscular dysplasia [28, 29, 30]and 1 each with moyamoya disease [18]and vertebral artery fenestration [31]. In 1 child, systemic lupus erythematosus [32]was described as a predisposing factor.…”

Section: Etiologymentioning

confidence: 99%

“…Oral anticoagulation therapy was administered to 7 children [1, 28, 30, 32, 44, 45]for a 3- to 6-month period either alone or after an initial course of parenteral heparin (table 4). Eight other children received similar treatment, but antiplatelet therapy was added in combination with anticoagulation therapy [8, 9, 17, 40, 42, 46, 47](table 4).…”

Section: Treatmentmentioning

confidence: 99%

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Vertebral Artery Dissection in Children: A Comprehensive Review

et al. 2002

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Vertebral artery dissection (VAD) has been infrequently recognized in children. The authors have reviewed 68 reported cases of VAD in children in the existing literature. An association between routine types of neck movement in sports and the evolution of VAD was recognized in half of the reported cases. Boys outnumbered girls by a ratio of 6.6 to 1, in contrast to adults, for whom the male to female ratio is approximately equal (1.3 to 1). Neck pain, one of the hallmark symptoms of VAD in adults, was infrequently noted in this young population (12%). Most children presented with various combinations of symptoms and signs, including ataxia (53%), headache (38%) and vomiting (34%). Eye signs or symptoms were noted in 72% of patients, and paresis/paralysis of one or more extremity occurred in 54%. Angiography was the method most frequently used to diagnose VAD (63/68; 93%). Magnetic resonance angiography (MRA) revealed pathognomonic signs of VAD in only 3 out of 13 patients evaluated (23%). In this series of 68 patients, 48 reports failed to indicate whether or not a cervical X-ray was performed, but in the 20 patients for whom such information was recorded, half had skeletal abnormalities in the occipital/atlas/axis region. The most common treatments were antiplatelet therapy (n = 15) and anticoagulation with (n = 8) or without (n = 7) supplemental antiplatelet therapy. Asymptomatic recovery occurred in 12 of the 15 patients (80%) who received antiplatelet therapy compared with 4 of the 15 patients (27%) who received anticoagulation therapy with or without antiplatelet therapy. There is a very high incidence of associated cervical anomalies in children with VAD. Further studies are required to determine if noninvasive examinations such as magnetic resonance imaging, ultrasonography, computed tomography angiography and MRA could replace angiography as the modality of choice in establishing the diagnosis of VAD in children. The role of different therapies for children presenting with symptoms related to VAD is unclear.

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Section: Prognosismentioning

confidence: 99%

Section: Etiologymentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

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Vertebral Artery Dissection in Children: A Comprehensive Review

et al. 2002

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“…These include previous cranial irradiation, progressive hemifacial atrophy, coarctation of the aorta, sickle cell disease, cardiac myxoma, arteriovenous malformations, fibromuscular dysplasia, tuberous sclerosis, Von-Hippel-Lindau disease, Diamond-Blackfan syndrome, Ehlers-Danlos syndrome and Marfan’s syndrome [13,14,15,16,17,18,19,20,21,22,23]. Multiple traumatic aneurysms are most uncommon and if unrecognized may present with fatal rupture [24,25,26].…”

Section: Discussionmentioning

confidence: 99%

“…These aneurysms are frequently giant in size and have a higher incidence of subarachnoid hemorrhage (SAH) as compared to the adult population [9, 10]. Multiple intracranial aneurysms in children are rare and there are only a few anecdotal reports in the literature [13,14,15,16,17,18,19,20,21,22,23]. A child with multiple aneurysms is presented and the pathogenesis and treatment options in such a case are discussed in light of the current literature.…”

Section: Introductionmentioning

confidence: 99%

Multiple Intracranial Aneurysms in a Child with Congenital Cyanotic Heart Disease

2006

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A 10-year-old child with transposition of the great arteries had multiple intracranial aneurysms. The child presented with pyogenic meningitis, and the investigations incidentally revealed numerous aneurysms involving both anterior and posterior circulation arteries. Angiography also revealed multiple fistulae between the internal and external carotid arteries. The child is under observation. The pathogenesis and management strategy of multiple intracranial aneurysms are discussed and the relevant literature is briefly reviewed.

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