Neurological Sciences

, Volume 27, Issue 5, pp 364–368 | Cite as

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

  • S. Bacigaluppi
  • R. Rusconi
  • P. Rampini
  • F. Annoni
  • M. L. Zavanone
  • V. Carnelli
  • S. M. Gaini
CASE REPORT

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 an underlying 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.

Key words

Vertebral artery dissection Spontaneous Non-traumatic Infection Therapy 

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Copyright information

© Springer-Verlag Italia 2006

Authors and Affiliations

  • S. Bacigaluppi
    • 1
  • R. Rusconi
    • 2
  • P. Rampini
    • 1
  • F. Annoni
    • 3
  • M. L. Zavanone
    • 1
  • V. Carnelli
    • 2
  • S. M. Gaini
    • 1
  1. 1.Department of NeurosurgeryUniversità degli Studi di Milano, Ospedale Policlinico, Mangiagalli e Regina Elena, Fondazione I.R.C.C.S.Milan Italy
  2. 2.Department of PediatricsUniversità degli Studi di Milano, Ospedale Policlinico, Mangiagalli e Regina Elena, Fondazione I.R.C.C.S.MilanItaly
  3. 3.Department of General SurgeryUniversità degli Studi di Milano, Ospedale Policlinico, Mangiagalli e Regina Elena, Fondazione I.R.C.C.S.MilanItaly

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