Pediatric traumatic carotid, vertebral and cerebral artery dissections: a review

Abstract

Traumatic cerebral dissections are rare but potentially dangerous conditions that through improved diagnostics have recently gained increased interest. However, there is still a significant lack of knowledge on the natural history, as well as on the best treatment options. Most of the literature on this topic consists of case reports and retrospective studies with no prospective randomized controlled studies. In our review, we highlight the fact that there is no level 1 evidence for the natural history of cerebral dissections or for the best treatment. We present 26 case studies derived from 70 pediatric patients affected by dissections, occlusions, and pseudoaneurysms.

Pediatric Cervical Spine Injuries

“…As this injury predominantly occurs in older children, the NEXUS criteria have a high sensitivity, representing the gold standard for decision making. [73][74][75][76] The incidence is between 0.7% and 3.8%. The cervicothoracic junction can be difficult to evaluate on plain radiographs, but a swimmer view can reveal an injury in this area.…”

“…11,29 Since predominantly bony injuries occur, plain radiographs are recommended. 73,75,76 Clinical presentation of CCAD is heterogeneous. CT is useful for assessment of the fracture pattern and clearance of the vertebral artery (Fig.…”

Internal carotid artery dissection at the supraclinoid portion after severe traumatic head injury in a child

“…Spontaneous dissections occur most commonly in older populations, but traumatic dissections are more prevalent in younger age groups. (1) Traumatic carotid artery (CA) dissection (tCAD) is a serious problem that results in neurological deficits and a mortality rate of up to 40%. (2) Traumatic CAD at the supraclinoid portion is extremely rare, especially in children.…”

Craniocervical Arterial Dissection in Children: Diagnosis and Treatment

“…This trend is due to increased availability of MRI/MRA, potential complications of CA (e.g. femoral hematoma, femoral arterial pseudoaneurysm, recurrent AIS, and radiation exposure), and the need for sedation in CA [22]. Additionally, as noninvasive techniques like MRI/MRA become more prevalent, fewer physicians are trained in CA, resulting in fewer experienced angiographers [24].…”

“…In most centers, MRI/MRA has become the first-line imaging modality for patients with suspected dissection [21,22]. MRI/MRA is noninvasive, uses no radiation, and simultaneously images for dissection and stroke.…”