Background Aneurysms affecting the posterior inferior cerebellar artery-vertebral artery complex (PICA-VA) represent 0,5–3% of all intracranial aneurysms and, in children, they are rarely recognised.
Most children present with eye symptoms, ataxia, headache, vomiting, limb paresis/paralysis and/or impaired consciousness. Neck pain, one of the hallmark symptoms in adults, is often absent.
Case report The authors present a 22 months infant, admitted at the Emergency Room after an episode of labial cyanosis and cutaneous pallor followed by prostration and altered gait pattern; without seizure or loss of consciousness. He presented hemodynamically stable, with right peripheral facial palsy, ipsilateral truncal imbalance and head rotation and refusal to walk. No evidence of oculoparesis, motor deficits or meningeal signs.
Brain CT-scan showed vascular dilation in the posterior cranial fossa, compressing medulla oblongata and pons structures. Angio-MR confirmed the presence of dissecting aneurysms of the right PICA and 4th segment of the right VA, with intramural thrombus and compression of the brainstem, without ischemia or bleeding.
A stent was placed in the PICA and an intravascular embolization coil in the VA. The child was discharged with no evidence of new neurological deficits.
An history of repeated minor head trauma in the context of tantrums was posteriorly clarified.
Conclusion In this case, as in literature, association between symptomatic PICA-VA aneurysms and minor head or cervical trauma seems possible. Often, there is no other underlying abnormality.
Despite the frightening presentation, prognosis is usually good. An endovascular approach seems to be safe and efficient in treating this condition.
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