Abstract
Objective: To describe a pediatric stroke syndrome with chronic focal
vertebral arteriopathy adjacent to cervical abnormalities.
Methods: At a single pediatric stroke center, we identified consecutive
children with stroke and vertebral arteriopathy of the V3 segment with
adjacent cervical bony or soft tissue abnormalities. We abstracted
clinical presentation, treatment and follow-up data from medical
charts. Results: From 2005-2016, ten children (all boys, ages 6
– 16 years) presented with posterior circulation strokes and vertebral
arteriopathy with adjacent cervical pathology. Two children had bony
abnormalities: one had a congenital arcuate foramen and one had os
odontoideum with cervical instability. In children without bony pathology,
vertebral artery narrowing during contralateral head rotation was
visualized by digital subtraction angiography. Eight boys had recurrent
ischemic events despite anti-thrombotic treatment (including 5 with
multiple recurrences) and were treated surgically to prevent additional
stroke. Procedures included vertebral artery decompression (n=6),
endovascular stent and spinal fusion (n=1), or vertebral artery
endovascular occlusion (n=1). In boys treated with decompression, cervical
soft tissue abnormalities (ruptured atlantoaxial bursa, ruptured joint
capsule or connective tissue scarring) were directly visualized during
open surgery. No other etiology for stroke or dissection was found in any
of the cases. Two boys without recurrent stroke were treated with activity
restriction and anti-thrombotics. At a median follow-up of 51 months
(range 17-84), there have been no additional recurrences. Conclusions:
Children with V3 segmental vertebral arteriopathy frequently have stroke
recurrence despite anti-thrombotics. Cervical bone imaging and angiography
with neck rotation can identify underlying pathology.