Aripirala Prasanthi, Reddy Nihaal, Lingappa Lokesh, Konanki Ramesh, Varma Dandu Ravi, Raju Subodh
Department of Pediatric Neurology, Rainbow Children's Hospital and Perinatal Center, Hyderabad, India.
Tenet Diagnostic Center and Rainbow Children's Hospital and Perinatal Center, Hyderabad, India.
Dev Med Child Neurol. 2023 Jun;65(6):847-854. doi: 10.1111/dmcn.15462. Epub 2022 Nov 15.
We aimed to evaluate the percentage of posterior circulation arterial ischaemic stroke (PCAIS) caused by craniovertebral junction (CVJ) anomalies and describe their clinical course. Children admitted to a tertiary care paediatric hospital with PCAIS between July 2017 and December 2020 were assessed retrospectively for disease aetiology. We reviewed the clinical, radiological, and surgical details of children with evidence of CVJ anomalies. Fourteen (24.1%) of 58 children admitted with arterial ischaemic stroke had posterior circulation involvement. The mean age of patients presenting with posterior circulation stroke was 6 years 6 months (range 3 months-15 years), 11 were male. Six of 14 cases with PCAIS were due to CVJ anomaly, their ages ranged from 4 months to 15 years (two age ranges were noted, 4 months-4 years and 11-15 years), four were male. Two children had atlantoaxial dislocation with basilar invagination, two had Bow Hunter syndrome with Chiari malformation type 1 (one with completed stroke), one had Chiari malformation type 1 alone, and one presented with Farber disease with proatlas segmentation anomaly in CVJ. The time lag to stroke and CVJ diagnosis ranged from 2 weeks to 24 months. A dynamic angiogram was required to evaluate biomechanical changes on scans with inconclusive findings on standard stroke imaging. CVJ anomalies are an important treatable cause of paediatric posterior circulation stroke. Cervical spine x-ray in flexion and extension should be done in all patients with posterior circulation stroke beyond the acute period. In cryptogenic aetiology, provocative angiography with guarded neck rotation should be considered to evaluate possible dynamic vertebral artery compression. WHAT THIS PAPER ADDS: Craniovertebral junction anomalies are an important cause of posterior circulation stroke in children. Evidence of flat occiput, short neck, and short stature in children with posterior circulation stroke should be assessed. Dynamic imaging helps identify dynamic vertebral artery compression.
我们旨在评估颅颈交界区（CVJ）异常所致后循环动脉缺血性卒中（PCAIS）的比例，并描述其临床病程。对2017年7月至2020年12月期间入住一家三级儿科医院且患有PCAIS的儿童进行回顾性病因评估。我们回顾了有CVJ异常证据的儿童的临床、影像学和手术细节。58例因动脉缺血性卒中入院的儿童中有14例（24.1%）出现后循环受累。出现后循环卒中的患者平均年龄为6岁6个月（范围3个月至15岁），其中11例为男性。14例PCAIS病例中有6例归因于CVJ异常，年龄范围为4个月至15岁（有两个年龄区间，4个月至4岁和11至15岁），4例为男性。2例儿童患有寰枢椎脱位伴基底凹陷，2例患有Bow Hunter综合征合并1型Chiari畸形（1例为完全性卒中），1例仅患有1型Chiari畸形，1例患有Farber病并伴有CVJ原寰椎节段异常。卒中与CVJ诊断之间的时间间隔为2周至24个月。对于标准卒中影像学检查结果不明确的扫描，需要进行动态血管造影以评估生物力学变化。CVJ异常是小儿后循环卒中重要的可治疗病因。所有度过急性期的后循环卒中患者均应进行颈椎屈伸位X线检查。对于病因不明的情况，应考虑进行保护性颈部旋转激发血管造影以评估可能的动态椎动脉受压情况。
颅颈交界区异常是儿童后循环卒中的重要病因。应评估后循环卒中儿童有无扁头、短颈和身材矮小的表现。动态成像有助于识别动态椎动脉受压情况。
