Disecciones arteriales craneocervicales en la edad pediátrica: ¿una patología emergente o infradiagnosticada?

Abstract

Cranio-cervical arterial dissections are a recognized cause of ischemic stroke in childhood, with an approximate incidence of 0.4 to 20%. AIM. To describe a population of children with cranio-cervical arterial dissections, analyzing clinical presentation, risk factors, angiographic findings, evolution and treatment. A descriptive, retrospective, longitudinal collaborative review (Sant Joan de Deu and Pereira Rossell Children's Hospital), of children one month to 17 years old of age was conducted, during the period of time between 2000 to 2009. Ten cases with arterial dissection were identified, 7 of them were boys and 3 girls. Nine had a traumatism preceding neurological symptoms. Clinical presentation included 5 patients with hemiparesis, 3 with hemicerebelus syndrome, 1 with VI cranial nerve palsy and 1 with intracranial soplus as the only symptom at physical examination. Three of them had seizures, while headache preceding the onset of cerebral ischemic symptoms was founded in 6 of them. Dissection involved anterior circulation in 5 patients and posterior circulation in the other 5. In reference to the localization of arterial compromise 4 patients had intracranial dissections and 6 had extracranial dissections. Anticoagulation therapy was done in 5, antiagregation in 3, and treatment abstention in two. None of them suffered neither complications due to anticoagulation therapy nor dead or recurrent dissections in long term follow up (2 months to 8 years). Cranio-cervical dissections are a frequent cause of stroke in childhood. Clinical suspicious related to cranio-cervical traumatisms and subsequent neurological symptoms should be high.