Vertebrobasilar strokes in children

ABSTRACT

This study describes the rare disorder of vertebrobasilar strokes in children and provides an assessment strategy to alert the clinician towards the possibility of this disorder. Method: A retrospective study of vertebrobasilar strokes over 20 years was conducted in the Neurology Department at the New Children's Hospital, Sydney, Australia. There were 6 males and 3 females between the ages of 18 months and 15 years. Frequently presenting features included headache, hemiparesis, ataxia and cranial nerve palsies. Aphasia occurred in 2 and afebrile seizures in 1 patient. Five patients had depressed consciousness extending to coma in 3. Etiological factors included trauma to the head or neck in 5, rheumatic endocarditis with artificial valve embolism in 1, brain stem encephalitis in 1 and undetermined etiology in 2. Diagnostic neuroimaging studies including MRI showed infarction in the territories of the occluded arteries. MRA showed occlusion of the vertebral artery and/or its branches in 5 patients, while the other 4 patients had involvement of the basilar artery and/or its branches. No abnormalities of blood coagulation were detected. Five patients were treated with anticoagulants. Acute hydrocephalus secondary to cerebellar infarction developed in 3 patients. Recurrent vertebrobasilar strokes were reported in 2 males, each of whom was treated surgically. There was 1 late death. Residual neurological deficits were seen in 5 patients and 3 made a complete recovery. Although this disorder is rare in pediatric patients, it is important to consider it in those children with appropriate neurological symptoms and signs