Abstract
Stroke caused by dissection of arteries of the vertebrobasilar system in children is still poorly investigated in terms of etiology, means of treatment, course of disease, and prognosis. The aim of this report was to describe the unusual course of a spontaneous dissection of the basilar artery (BA) in a child treated with endovascular techniques and to point out that the plasticity of the brain stem can fully compensate for structural damage caused by stroke. We report the case of a 15-year-old boy who suffered a wake-up stroke with BA occlusion caused by spontaneous dissection. A blood clot was aspirated from the false lumen and the true lumen re-opened, but the patient deteriorated a few hours later, and repeated angiography revealed that the intimal flap was detached, occluding the BA again. The lumen of BA was then reconstructed by a stent. Despite a large pons infarction, the patient was completely recovered 11 months after the onset. The case was analyzed with angiograms and magnetic resonance imaging, macroscopic and microscopic pathological analysis, computed tomographic angiography, magnetic resonance-based angiography, and diffusion tensor imaging. This case illustrates that applied endovascular techniques and intensive care measures can alter the course of potentially fatal brain stem infarction. Our multimodal analysis gives new insight into the anatomical basis for the plasticity mechanism of the brain stem.
Highlights
A spontaneous dissection of arteries of the vertebrobasilar system in children is a rare clinical condition, and a dissection which involves only the basilar artery (BA) with intact vertebral arteries is even more uncommon [1,2,3]
Songsaeng et al reported on eight children, aged between 1 and 12 years, with spontaneous dissections of intracranial arteries, three of them with spontaneous dissection of the BA
The same group reported on 29 children with vertebrobasilar dissections in which, besides the conservative treatment, open surgical and EV techniques were applied with varying results [11]
Summary
A spontaneous dissection of arteries of the vertebrobasilar system in children is a rare clinical condition, and a dissection which involves only the basilar artery (BA) with intact vertebral arteries is even more uncommon [1,2,3]. Conservative treatment has been the standard approach in patients with spontaneous dissections [4]. He fell asleep quickly, and his parents did not notice anything unusual during his sleep. A computerized tomographic angiography (CTA) showed occlusion of the BA at the level of anterior inferior cerebellar arteries (AICAs). The CTA finding was confirmed with conventional angiography (Fig. 1a). A coaxial system consisting of 8F Infinity long sheath (Stryker, Fremont, CA, USA) and 6F SOFIA distal access catheter (DAC)
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