RESIDENT
& FELLOW
SECTION
Section Editor
Mitchell S.V. Elkind,
MD, MS

Bernhard Suter, MD
Lisa Michael El-Hakam,
MD

Child Neurology:
Stroke due to nontraumatic intracranial
dissection in a child
Figure

MRI and catheter angiography

Address correspondence and
reprint requests to Dr. Lisa
Michael El-Hakam, Department
of Pediatric Neurology, Baylor
College of Medicine, Texas
Children’s Hospital, 6621 Fannin
St. CC 1250, Houston, TX
77030-2399
hakam@bcm.edu

(A, B) Diffusion-weighted sequence of MRI of the brain shows acute infarction in the right middle cerebral artery (MCA)
territory. (C, D) Catheter angiography showed irregularities of the right supraclinoid internal carotid artery, extending into
the M1 segment of the right MCA. An intimal flap (arrow) indicates dissection.

A 9-year-old girl without prior trauma presented
with weakness and headache. Examination showed
profound left hemiplegia. MRI demonstrated a right
middle cerebral artery (MCA) territory infarction.
Magnetic resonance angiography showed proximal
right MCA irregularity. Conventional angiography
revealed an intracranial dissection (figure).
Intracranial dissections are frequently spontaneous (nontraumatic) and are associated with stroke in
the young, comprising 60% of anterior circulation
dissections in childhood.1 Exclusion of intracranial
dissections is challenging using magnetic resonance
angiography; cerebral angiography must be consid-

ered.2 Potential treatments include anticoagulation
and antiplatelet therapies; Class III recommendations discourage anticoagulation because of the association of subarachnoid hemorrhage with intracranial
dissection.2
REFERENCES
1.
Fullerton HJ, Johnston SC, Smith WS. Arterial dissection
and stroke in children. Neurology 2001;57:1155–1160.
2.
Roach ES, Golomb MR, Adams R, et al. Management of
stroke in infants and children: a scientific statement from a
Special Writing Group of the American Heart Association
Stroke Council and the Council on Cardiovascular Disease
in the Young. Stroke 2008;39:2644–2691.

From the Department of Pediatric Neurology, Texas Children’s Hospital, Baylor College of Medicine, Houston.
Disclosure: The authors report no disclosures.

e100

Copyright © 2009 by AAN Enterprises, Inc.

Child Neurology: Stroke due to nontraumatic intracranial dissection in a child
Bernhard Suter and Lisa Michael El-Hakam
Neurology 2009;72;e100
DOI 10.1212/WNL.0b013e3181a55f52
This information is current as of May 11, 2009
Updated Information &
Services

including high resolution figures, can be found at:
http://www.neurology.org/content/72/19/e100.full.html

References

This article cites 2 articles, 2 of which you can access for free at:
http://www.neurology.org/content/72/19/e100.full.html##ref-list-1

Subspecialty Collections

This article, along with others on similar topics, appears in the
following collection(s):
All Cerebrovascular disease/Stroke
http://www.neurology.org//cgi/collection/all_cerebrovascular_disease_
stroke
Carotid artery dissection
http://www.neurology.org//cgi/collection/carotid_artery_dissection
Childhood stroke
http://www.neurology.org//cgi/collection/childhood_stroke

Permissions & Licensing

Information about reproducing this article in parts (figures,tables) or in
its entirety can be found online at:
http://www.neurology.org/misc/about.xhtml#permissions

Reprints

Information about ordering reprints can be found online:
http://www.neurology.org/misc/addir.xhtml#reprintsus

Neurology ® is the official journal of the American Academy of Neurology. Published continuously since
1951, it is now a weekly with 48 issues per year. Copyright . All rights reserved. Print ISSN: 0028-3878.
Online ISSN: 1526-632X.