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

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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.

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References

  1. Agner C, Weig SG (2005) Arterial dissection and stroke following child abuse: case report and review of the literature. Childs Nerv Syst 21:416–420

    Article  PubMed  Google Scholar 

  2. An TL (1992) Fatal dissecting aneurysm of the internal carotid artery with delayed symptoms following facial impact. J Forensic Sci 37:646–651

    PubMed  CAS  Google Scholar 

  3. Bar T, Zagury A, Nahlieli O, London D, Yoffe B, Bibi H (2002) Delayed signs and symptoms after oropharyngeal trauma in a child. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 94:15–17

    Article  PubMed  Google Scholar 

  4. Berlot G, Nicolazzi G, Viviani M, Silvestri L, Tomasini A, Gullo A, Cloffi V, Bussani R (1996) Traumatic blunt carotid injury: clinical experience and review of the literature. Eur J Emerg Med 3:36–42

    Article  PubMed  CAS  Google Scholar 

  5. Biller J, Hingtgen WL, Adams HP Jr, Smoker WRK, Goderky JC, Toffol GJ (1986) Cervicocecephalic arterial dissections. A ten-year experience. Arch Neurol 43:1234–1238

    PubMed  CAS  Google Scholar 

  6. Borges G, Bonilha L, Santos SF, Carelli EF, Fernandes YB, Ramina R, Zanardi V, Menezes JR, Nogueira RJ (2000) Thrombosis of the internal carotid artery secondary to soft palate injury in children and childhood. Report of two cases. Pediatr Neurosurg 32:150–153

    Article  PubMed  CAS  Google Scholar 

  7. Brunworth LS, Cothren CC, Kimm GE, Biffl WL, Moore EE (2009) Pediatric blunt vertebral artery injury: case report and treatment plan. J Pediatr Surg 44:e5–e9

    Article  PubMed  Google Scholar 

  8. Chabrier S, Lasjaunias P, Husson B, Landrieu P, Tardieu M (2003) Ischaemic stroke from dissection of the craniocervical arteries in childhood: report of 12 patients. Eur J Paediatr Neurol 7:39–42

    Article  PubMed  Google Scholar 

  9. Chamoun RB, Mawad ME, Whitehead WE, Luerssen TG, Jea A (2008) Extracranial traumatic carotid artery dissections in children: a review of current diagnosis and treatment options. J Neurosurg Pediatr 2:101–108

    Article  PubMed  Google Scholar 

  10. Chapleau CE, Robertson JT (1981) Spontaneous cervical carotid dissection: outpatient treatment with continuous heparin infusion using a totally implantable infusion device. Neurosurgery 8:83–87

    Article  PubMed  CAS  Google Scholar 

  11. Cloft H, Jensen M, Kallmes D, Dion J (2000) Arterial dissections complicating cerebral angiography and cerebrovascular interventions. Am J Neuroradiol 21:541–545

    PubMed  CAS  Google Scholar 

  12. Cothren C, Moore E, Biffl W, Ciesla D, Ray C, Johnson J (2004) Anticoagulation is the gold standard therapy for blunt carotid injuries to reduce stroke rate. Arch Surg 139:540–546

    Article  PubMed  Google Scholar 

  13. de Borst GJ, Slieker MG, Monteiro LM, Moll FL, Braun KP (2006) Bilateral traumatic carotid artery dissection in a child. Pediatr Neurol 34:408–411

    Article  PubMed  Google Scholar 

  14. Desfontaines P, Despland PA (1995) Dissection of the internal carotid artery: aetiology, symptomatology, clinical and neurosonological follow-up, and treatment in 60 consecutive cases. Acta Neurol Belg 95:226–234

    PubMed  CAS  Google Scholar 

  15. Duke BJ, Partington MD (1996) Blunt carotid injury in children. Pediatr Neurosurg 25:188–193

    Article  PubMed  CAS  Google Scholar 

  16. Fassett DR, Dailey AT, Vaccaro AR (2008) Vertebral artery injuries associated with cervical spine injuries: a review of the literature. J Spinal Disord Tech 21:252–258

    Article  PubMed  Google Scholar 

  17. Frantzen E, Jacobsen HH, Therkelsen J (1961) Cerebral artery occlusions in children due to trauma to the head and neck. A report of 6 cases verified by cerebral angiography. Neurology 11:695–700

    PubMed  CAS  Google Scholar 

  18. Fullerton HJ, Johnston SC, Smith WS (2001) Arterial dissection and stroke in children. Neurology 57:1155–1160

    PubMed  CAS  Google Scholar 

  19. Ganesan V, Kirkham FJ (1997) Carotid dissection causing stroke in a child with migraine. BMJ 314:291–292

    Article  PubMed  CAS  Google Scholar 

  20. Giroud M, Fayolle H, Andre N et al (1994) Incidence of internal carotid artery dissection in the community of Dijon. J Neurol Neurosurg Psychiatry 57:1443

    Article  PubMed  CAS  Google Scholar 

  21. Hardin CA, Snodgrass RG (1964) Dissecting aneurysm of internal carotid artery treated by fenestration and graft. Surgery 55:207–209

    PubMed  CAS  Google Scholar 

  22. Horowitz IN, Niparko NA (1994) Vertebral artery dissection with bilateral hemiparesis. Pediatr Neurol 11:252–254

    Article  PubMed  CAS  Google Scholar 

  23. Hughes KM, Collier B, Greene KA, Kurek S (2000) Traumatic carotid artery dissection: a significant incidental finding. Am Surg 66:1023–1027

    PubMed  CAS  Google Scholar 

  24. Jacob JC, Maroun FB, Heneghan WD, House AM (1970) Uncommon cerebrovascular lesions in children. Dev Med Child Neurol 12:446–453

    Article  PubMed  CAS  Google Scholar 

  25. Jariwala SP, Crowley JG, Roychowdhury S (2006) Trauma-induced extracranial internal carotid artery dissection leading to multiple infarcts in a young girl. Pediatr Emerg Care 22:737–742

    Article  PubMed  Google Scholar 

  26. Kak VK, Gordon DS (1972) Internal carotid artery thrombosis following head injury in a 17-month-old child. Neurochirurgia (Stuttg) 15:222–226

    CAS  Google Scholar 

  27. Kieslich M, Fiedler A, Heller C, Kreuz W, Jacobi G (2002) Minor head injury as cause and co-factor in the aetiology of stroke in childhood: a report of eight cases. J Neurol Neurosurg Psychiatry 73:13–16

    Article  PubMed  CAS  Google Scholar 

  28. Levack MM, Pettitt BJ, Winston AD (2009) Carotid artery thrombosis and delayed stroke associated with the use of a shoulder belt in a teenager. J Pediatr Surg 44:E29–E33

    Article  PubMed  Google Scholar 

  29. Lew SM, Frumiento C, Wald SL (1999) Pediatric blunt carotid injury: a review of the National Pediatric Trauma Registry. Pediatr Neurosurg 30:239–244

    Article  PubMed  CAS  Google Scholar 

  30. Lin JJ, Chou ML, Lin KL, Wong MC, Wang HS (2007) Cerebral infarct secondary to traumatic carotid artery dissection. Pediatr Emerg Care 23:166–168

    Article  PubMed  Google Scholar 

  31. Liu AY, Paulsen RD, Marcellus ML et al (1999) Long-termoutcomes after carotid stent placement for treatment of carotid artery dissection. Neurosurgery 45:1368–1374

    Article  PubMed  CAS  Google Scholar 

  32. Mann CI, Dietrich RB, Schrader MT, Peck WW, Demos DS, Bradley WG Jr (1993) Posttraumatic carotid artery dissection in children: evaluation with MR angiography. AJR Am J Roentgenol 160:134–136

    PubMed  CAS  Google Scholar 

  33. Martin RF, Eldrup-Jorgensen J, Clark DE, Bredenberg CE (1991) Blunt trauma to the carotid arteries. J Vasc Surg 14:789–793, discussion 793–785

    Article  PubMed  CAS  Google Scholar 

  34. McNeill DH Jr, Dreisbach J, Marsden RJ (1980) Spontaneous dissection of the internal carotid artery: its conservative management with heparin sodium. Arch Neurol 37:54–55

    PubMed  Google Scholar 

  35. Mokri B, Sundt TM Jr, Houser OW et al (1986) Spontaneous dissection of the cervical internal carotid artery. Ann Neurol 19:126–138

    Article  PubMed  CAS  Google Scholar 

  36. Moriarty KP, Harris BH, Benitez-Marchand K (1997) Carotid artery thrombosis and stroke after blunt pharyngeal injury. J Trauma 42:541–543

    Article  PubMed  CAS  Google Scholar 

  37. Nance J, Abbott K, Morris L, Couper R (1997) An unfortunate consequence of being tickled. Lancet 349:1142

    Article  PubMed  CAS  Google Scholar 

  38. Nunnink L (2002) Blunt carotid artery injury. Emerg Med (Fremantle) 14:412–421

    Article  Google Scholar 

  39. Okada Y, Shima T, Nishida M, Yamane K, Kagawa R (1999) Traumatic dissection of the common carotid artery after blunt injury to the neck. Surg Neurol 51:513–519, discussion 519-20

    Article  PubMed  CAS  Google Scholar 

  40. Park SH, Sung JK, Hwang SK (2005) Traumatic vertebral artery dissection in a child with brachial plexus injury. Pediatr Neurosurg 41:141–144

    Article  PubMed  Google Scholar 

  41. Payton TF, Siddiqui KM, Sole DP, McKinley DF (2004) Traumatic dissection of the internal carotid artery. Pediatr Emerg Care 20:27–29

    Article  PubMed  Google Scholar 

  42. Pierrot S, Bernardeschi D, Morrisseau-Durand MP, Manach Y, Couloigner V (2006) Dissection of the internal carotid artery following trauma of the soft palate in children. Ann Otol Rhinol Laryngol 115:323–329

    PubMed  Google Scholar 

  43. Pozzati E, Giuliani G, Poppi M, Faenza A (1989) Blunt traumatic carotid dissection with delayed symptoms. Stroke 20:412–416

    Article  PubMed  CAS  Google Scholar 

  44. Rajz G, Simon D, Bakon M, Goren O, Zauberman J, Zibly Z, Zimlichman E, Harnof S (2009) Traumatic carotid artery dissection. Isr Med Assoc J 11:507–508

    PubMed  Google Scholar 

  45. Ramgren B, Cronqvist M, Romner B, Brandt L, Holtås S, Larsson EM (2005) Vertebrobasilar dissection with subarachnoid hemorrhage: a retrospective study of 29 patients. Neuroradiology 47:97–104

    Article  PubMed  CAS  Google Scholar 

  46. Redekop GJ (2008) Extracranial carotid and vertebral artery dissection: a review. Can J Neurol Sci 35:146–152

    PubMed  Google Scholar 

  47. Reid JD, Weigelt JA (1998) Forty-three cases of vertebral artery trauma. J Trauma 28:1007–1012

    Article  Google Scholar 

  48. Robertson DI, Stuckey SL (2003) Isolated intrapetrous carotid canal atraumatic internal carotid artery dissection: MRI and digital subtraction angiography findings. Australas Radiol 47:462–464

    Article  PubMed  Google Scholar 

  49. Sack JA, Etame AB, Shah GV, La Marca F, Park P (2009) Management and outcomes of patients undergoing surgery for traumatic cervical fracture-subluxation associated with an asymptomatic vertebral artery injury. J Spinal Disord Tech 22:86–90

    Article  PubMed  Google Scholar 

  50. Schellinger PD, Schwab S, Krieger D, Fiebach JB, Steiner T, Hund EF et al (2001) Masking of vertebral artery dissection by severe trauma to the cervical spine. Spine (Phila Pa 1976) 26:314–319

    Article  CAS  Google Scholar 

  51. Schievink WI (2001) Spontaneous dissection of the carotid and vertebral arteries. N Engl J Med 344:898–906

    Article  PubMed  CAS  Google Scholar 

  52. Schneidereit N, Simons R, Nicolau S, Graeb D, Brown D, Kirkpatrick A et al (2006) Utility of screening for blunt vascular neck injuries with computed tomographic angiography. J Trauma 60:209–216

    Article  PubMed  Google Scholar 

  53. Singh RR, Thomas AA, Barry MC, Bouchier-Hayes DJ (2004) Traumatic pseudoaneurysm of the internal carotid artery presenting with oculosympathetic palsy. Ir J Med Sci 173:162–163

    Article  PubMed  CAS  Google Scholar 

  54. Stringer WL, Kelly DL Jr (1980) Traumatic dissection of the extracranial internal carotid artery. Neurosurgery 6:123–130

    Article  PubMed  CAS  Google Scholar 

  55. Sturzenegger M (1994) Headache and neck pain: the warning symptoms of vertebral artery dissection. Headache 34:187–193

    Article  PubMed  CAS  Google Scholar 

  56. Sturzenegger M (1995) Spontaneous internal carotid artery dissection: early diagnosis and management in 44 patients. J Neurol 242:231–238

    Article  PubMed  CAS  Google Scholar 

  57. Suechting RL, French LA (1955) Posterior inferior cerebellar artery syndrome following a fracture of the cervical vertebrae. J Neurosurg 12:187–189

    Article  PubMed  CAS  Google Scholar 

  58. Torina PJ, Flanders AE, Carrino JA, Burns AS, Friedman DP, Harrop JS, Vacarro AR (2005) Incidence of vertebral artery thrombosis in cervical spine trauma: correlation with severity of spinal cord injury. AJNR Am J Neuroradiol 26:2645–2651

    PubMed  Google Scholar 

  59. Verneuil AAS (1872) Contusions multiples; delire violent; hemiplegie a droite, signes de compression cerebrales. Bull Acad Natl Méd 36:46–56

    Google Scholar 

  60. Watridge CB, Muhlbauer MS, Lowery RD (1989) Traumatic carotid artery dissection: diagnosis and treatment. J Neurosurg 71:854–857

    Article  PubMed  CAS  Google Scholar 

  61. Wolfe SQ, Mueller-Kronast N, Aziz-Sultan MA, Zauner A, Bhatia S (2008) Extracranial carotid artery pseudoaneurysm presenting with embolic stroke in a pediatric patient. Case report. J Neurosurg Pediatr 1:240–243

    Article  PubMed  Google Scholar 

  62. Wraige E, Pohl KR, Ganesan V (2005) A proposed classification for subtypes of arterial ischemic stroke in children. Dev Med Child Neurol 47:252–256

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Division of Neurological Surgery, Department of Surgery, University of Alabama, Birmingham, AL, USA

    Martin M. Mortazavi, Ketan Verma, R. Shane Tubbs & Mark Harrigan

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  1. Martin M. Mortazavi
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  2. Ketan Verma
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Correspondence to R. Shane Tubbs.

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Mortazavi, M.M., Verma, K., Tubbs, R.S. et al. Pediatric traumatic carotid, vertebral and cerebral artery dissections: a review. Childs Nerv Syst 27, 2045–2056 (2011). https://doi.org/10.1007/s00381-011-1409-x

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