Sorrentino Dante, Biehler Jefry L, Warman Roberto
From the *Florida International University Herbert Wertheim College of Medicine; †Miami Children's Hospital, Florida International University Herbert Wertheim College of Medicine and ‡Pediatric Ophthalmology Consultants, Bascom Palmer Eye Institute, Miami, FL.
Pediatr Emerg Care. 2015 Dec;31(12):856-9. doi: 10.1097/PEC.0000000000000632.
Spontaneous dissection of the vertebral artery is a dangerous and often underdiagnosed cause of posterior circulation and occipital lobe stroke in the young. Vertebral artery dissection should be considered in young patients with a history of minor, nontraumatic changes in head position and visual disturbances.
Clinical records for this patient were retrospectively reviewed at Miami Children's Hospital and associated pediatric ophthalmology clinic.
A previously healthy 8-year-old boy presented to the emergency department with a 2-day history of headache and blurred vision that developed after going on a high-velocity amusement park ride. Confrontation visual field testing showed a subtle superior visual field deficit superiorly. Computer topography scan of the head without contrast was performed and showed bilateral occipital hypodense lesions consistent with ischemic infarction. A filling defect was seen in the transverse portion of the right vertebral artery at the level of C2 as it exited the right transverse foramen, consistent with an acute arterial dissection at this level. Automated visual field testing showed macular sparing left homonymous superior quadrantanopia.
Most patients with vertebral artery dissection present with signs of posterior circulation ischemia consisting of neurological deficits, headaches, or neck pain. This case report highlights the unique clinical features and diagnostic imaging seen in the work-up of this rare disease process and exemplifies the importance of identifying acute visual symptoms in an emergency situation.
椎动脉自发性夹层是年轻人后循环和枕叶卒中的一个危险且常被漏诊的病因。对于有轻微、非创伤性头部位置改变和视觉障碍病史的年轻患者，应考虑椎动脉夹层。
对迈阿密儿童医院及相关儿科眼科诊所该患者的临床记录进行回顾性分析。
一名既往健康的8岁男孩因在高速游乐园游乐设施游玩后出现2天头痛和视力模糊而就诊于急诊科。对视野检查显示上方有轻微的上象限视野缺损。进行了无对比剂的头部计算机断层扫描，显示双侧枕叶低密度病变，符合缺血性梗死。在右侧椎动脉穿出右侧横突孔的C2水平横段可见充盈缺损，符合该水平的急性动脉夹层。自动视野检查显示黄斑回避性左侧同向性上象限偏盲。
大多数椎动脉夹层患者表现为后循环缺血的体征，包括神经功能缺损、头痛或颈部疼痛。本病例报告突出了在这一罕见疾病过程检查中所见的独特临床特征和诊断影像学表现，并例证了在紧急情况下识别急性视觉症状的重要性。
