Dlamini Nomazulu, Freeman Jeremy L, Mackay Mark T, Hawkins Cynthia, Shroff Manohar, Fullerton Heather J, Deveber Gabrielle A
Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada.
J Child Neurol. 2011 Sep;26(9):1203-6. doi: 10.1177/0883073811408904. Epub 2011 Jul 8.
Transient cerebral arteriopathy is a frequent cause of childhood arterial ischemic stroke. Differentiating this condition from intracranial carotid artery dissection is challenging but important for initial treatment. We describe 4 cases from the International Pediatric Stroke Study of intracranial carotid artery dissection, initially misdiagnosed as transient cerebral arteriopathy. Presentations were abrupt, with focal neurological deficits in 4, preceding headache in 3, and minor trauma in 1. Infarcts involved the anterior circulation, and magnetic resonance angiography showed unilateral arterial stenosis/occlusion. None had evidence of dissection. All received anticoagulation or thrombolysis. Three died from refractory intracranial hypertension. Intracranial carotid artery dissection was confirmed postmortem (n = 3) and on dedicated MR wall imaging showing intramural hematoma (n = 1). In differentiating transient cerebral arteriopathy from intracranial carotid artery dissection, routine magnetic resonance angiography is unreliable and adjunctive conventional angiography, gadolinium magnetic resonance angiography, or dedicated MRI wall imaging should be considered.
短暂性脑动脉病是儿童动脉缺血性卒中的常见病因。将这种情况与颅内颈动脉夹层分离相鉴别具有挑战性，但对于初始治疗很重要。我们描述了国际儿童卒中研究中的4例颅内颈动脉夹层分离病例，这些病例最初被误诊为短暂性脑动脉病。临床表现为急性起病，4例有局灶性神经功能缺损，3例有前驱头痛，1例有轻微外伤。梗死累及前循环，磁共振血管造影显示单侧动脉狭窄/闭塞。均无夹层分离的证据。所有患者均接受了抗凝或溶栓治疗。3例死于难治性颅内高压。3例尸检确诊为颅内颈动脉夹层分离，1例通过专门的磁共振血管壁成像显示壁内血肿确诊。在鉴别短暂性脑动脉病与颅内颈动脉夹层分离时，常规磁共振血管造影不可靠，应考虑辅助性传统血管造影、钆增强磁共振血管造影或专门的磁共振血管壁成像。
