Khurana D S, Bonnemann C G, Dooling E C, Ouellette E M, Buonanno F
Department of Neurology, Massachusetts General Hospital, Boston 02114, USA.
Pediatr Neurol. 1996 Apr;14(3):255-8. doi: 10.1016/0887-8994(96)00015-x.
Vertebral artery dissection is an uncommon cause of stroke in children. Accuracy of diagnosis by magnetic resonance angiography (MRA) instead of invasive transfemoral angiography (TFA) has been controversial. The need for anticoagulation and duration of such therapy is also arguable. We report 2 boys with vertebral artery dissection: one, aged 7 years, presented with hemiparesis and seizures and the other, aged 4 years, presented with ataxia. Each boy's initial MRA was not interpreted as delineating occlusive lesions to explain the posterior circulation infarcts visualized on computed tomography and magnetic resonance imaging scans. However, subsequent MRAs were suspicious for vertebral artery dissection, which was confirmed by TFA. Both children were treated with anticoagulation therapy. The first patient continued to manifest evidence of new infarcts despite treatment (initially with aspirin alone, followed by anticoagulation with heparin and warfarin), and is now maintained on a combination of high dose warfarin and aspirin. The second patient is now maintained on aspirin alone after initial anticoagulation for 6 months with heparin followed by warfarin. A high index of suspicion for vertebral artery dissection may allow diagnosis on the basis of MRA alone. Previous reports have indicated good outcomes of vertebral artery dissection in children and adults irrespective of anticoagulation treatment. Our experience suggests that anticoagulation may be beneficial in preventing further strokes caused by the dissection.
椎动脉夹层是儿童中风的一种罕见病因。通过磁共振血管造影（MRA）而非侵入性股动脉血管造影（TFA）进行诊断的准确性一直存在争议。抗凝治疗的必要性及疗程也尚无定论。我们报告了2例椎动脉夹层的男孩：1例7岁，表现为偏瘫和癫痫发作；另1例4岁，表现为共济失调。每个男孩最初的MRA检查结果均未显示出可解释计算机断层扫描和磁共振成像扫描中所见后循环梗死的闭塞性病变。然而，随后的MRA检查怀疑为椎动脉夹层，并经TFA证实。两名患儿均接受了抗凝治疗。第一名患者尽管接受了治疗（最初仅使用阿司匹林，随后使用肝素和华法林进行抗凝），仍持续出现新梗死灶的迹象，目前维持高剂量华法林和阿司匹林联合治疗。第二名患者在最初使用肝素抗凝6个月后使用华法林，之后仅维持使用阿司匹林治疗。对椎动脉夹层保持高度怀疑指数可能仅基于MRA就能做出诊断。先前的报告表明，无论是否进行抗凝治疗，儿童和成人椎动脉夹层的预后都较好。我们的经验表明，抗凝治疗可能有助于预防夹层导致的进一步中风。
