Aim Stroke due to spontaneous carotid artery dissection (SCAD) is rare in children. We report a new paediatric case of SCAD and we insist on early diagnosis and treatment.
Report A 29-month-old boy was admitted with abrupt onset of hemiplegia and aphasia. The symptoms appeared 1 week after bronchitis. There was no history of trauma to the head or neck, nor was there a history of drug intake or similar events in the past. On admission, he was afebrile, normotensive but pale and mildly dehydrated. He had global aphasia with inability to speak or understand simple commands. Neurological evaluation revealed mild right weakness and right-sided flaccid hemiparesis with depressed muscle stretch reflexes. Magnetic resonance angiography (MRA) demonstrated dissection of the left extracranial internal carotid artery and thrombosis of intrapetrous and intracavernous portion. Biological investigations were normal apart from a severe hypochromic anaemia Hb = 7 g/dl related to iron deficiency. Chest roentgenography, echocardiography and cervical spine roentgenography were also normal. After 21 days of anticoagulation, a second MRA showed a persistent thrombosis of the intracranial carotid artery and Sylvain stroke. previous treatment was changed to antiplatelet agents. At 18-months follow-up, the boy had a normal mental status but usually suffers from a right hemiparesis.
Conclusion Spontaneous dissection of the cervicocerebral arteries is a dramatic event that may occur not only in young adults but also in children. It requires astute recognition because early treatment by heparin may significantly reduce the neurological sequelae.