Craniocervical Arterial Dissection in Children: Pathophysiology and Management
Craniocervical arterial dissection is a commonly reported arteriopathy associated with stroke in children. It is characterized by a high stroke recurrence rate and variable outcomes. Here we review the pathophysiology, clinical presentation, and diagnostic neuroimaging approaches that are helpful in...
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Veröffentlicht in: | Pediatric neurology 2019-06, Vol.95, p.9-18 |
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description | Craniocervical arterial dissection is a commonly reported arteriopathy associated with stroke in children. It is characterized by a high stroke recurrence rate and variable outcomes. Here we review the pathophysiology, clinical presentation, and diagnostic neuroimaging approaches that are helpful in accurate diagnosis and follow-up of children with arterial dissection.
MEDLINE searches (2000 to 2018) for articles that contained patients aged less than 18 years with craniocervical arterial dissection was performed, with the goal of analyzing their presenting features, pathophysiological mechanisms, and imaging characteristics and interventions.
Sixteen articles met the study criteria and reported 182 cases of craniocervical arterial dissection, 68% male, average age 8.6 years. Dissection was associated with head and neck trauma in 56% of the cases and frequently involved the posterior (61%) and extracranial locations (64%); the vertebral artery was the most commonly involved artery (60%). The most common clinical presentation was hemiparesis (80/160, 50%), followed by headache (64/164, 39%). Magnetic resonance imaging was the preferred neuroimaging method, followed by cerebral catheter angiography as a gold standard definitive neurovascular imaging modality when the initial vascular imaging revealed nondiagnostic findings.
The diagnosis of arterial dissection requires a high index of suspicion and consideration for detailed neurovascular imaging, including both the cranial and cervical regions. Neurovascular imaging challenges, especially visualization of arterial abnormalities, highlight the importance of appropriate and timely use of specific neurovascular imaging techniques. Magnetic resonance imaging appears to be the preferred neurovascular imaging modality in children with arterial dissection and may obviate the need for invasive cerebral catheter angiography. |
doi_str_mv | 10.1016/j.pediatrneurol.2019.01.020 |
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MEDLINE searches (2000 to 2018) for articles that contained patients aged less than 18 years with craniocervical arterial dissection was performed, with the goal of analyzing their presenting features, pathophysiological mechanisms, and imaging characteristics and interventions.
Sixteen articles met the study criteria and reported 182 cases of craniocervical arterial dissection, 68% male, average age 8.6 years. Dissection was associated with head and neck trauma in 56% of the cases and frequently involved the posterior (61%) and extracranial locations (64%); the vertebral artery was the most commonly involved artery (60%). The most common clinical presentation was hemiparesis (80/160, 50%), followed by headache (64/164, 39%). Magnetic resonance imaging was the preferred neuroimaging method, followed by cerebral catheter angiography as a gold standard definitive neurovascular imaging modality when the initial vascular imaging revealed nondiagnostic findings.
The diagnosis of arterial dissection requires a high index of suspicion and consideration for detailed neurovascular imaging, including both the cranial and cervical regions. Neurovascular imaging challenges, especially visualization of arterial abnormalities, highlight the importance of appropriate and timely use of specific neurovascular imaging techniques. Magnetic resonance imaging appears to be the preferred neurovascular imaging modality in children with arterial dissection and may obviate the need for invasive cerebral catheter angiography.</description><identifier>ISSN: 0887-8994</identifier><identifier>EISSN: 1873-5150</identifier><identifier>DOI: 10.1016/j.pediatrneurol.2019.01.020</identifier><identifier>PMID: 30955992</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adolescent ; Aneurysm, Dissecting - diagnostic imaging ; Aneurysm, Dissecting - therapy ; Arterial imaging ; Cerebral Angiography - methods ; Child ; Child, Preschool ; Disease Management ; Dissection ; Humans ; Infant ; Intracranial Aneurysm - diagnostic imaging ; Intracranial Aneurysm - therapy ; Pathophysiology ; Stroke</subject><ispartof>Pediatric neurology, 2019-06, Vol.95, p.9-18</ispartof><rights>2019 Elsevier Inc.</rights><rights>Copyright © 2019 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c383t-c2cc67bcd84589c2e3afaf888db464a2a10b244bb7ab4c94107524ae1b6dece13</citedby><cites>FETCH-LOGICAL-c383t-c2cc67bcd84589c2e3afaf888db464a2a10b244bb7ab4c94107524ae1b6dece13</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.pediatrneurol.2019.01.020$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30955992$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nash, Monica</creatorcontrib><creatorcontrib>Rafay, Mubeen F.</creatorcontrib><title>Craniocervical Arterial Dissection in Children: Pathophysiology and Management</title><title>Pediatric neurology</title><addtitle>Pediatr Neurol</addtitle><description>Craniocervical arterial dissection is a commonly reported arteriopathy associated with stroke in children. It is characterized by a high stroke recurrence rate and variable outcomes. Here we review the pathophysiology, clinical presentation, and diagnostic neuroimaging approaches that are helpful in accurate diagnosis and follow-up of children with arterial dissection.
MEDLINE searches (2000 to 2018) for articles that contained patients aged less than 18 years with craniocervical arterial dissection was performed, with the goal of analyzing their presenting features, pathophysiological mechanisms, and imaging characteristics and interventions.
Sixteen articles met the study criteria and reported 182 cases of craniocervical arterial dissection, 68% male, average age 8.6 years. Dissection was associated with head and neck trauma in 56% of the cases and frequently involved the posterior (61%) and extracranial locations (64%); the vertebral artery was the most commonly involved artery (60%). The most common clinical presentation was hemiparesis (80/160, 50%), followed by headache (64/164, 39%). Magnetic resonance imaging was the preferred neuroimaging method, followed by cerebral catheter angiography as a gold standard definitive neurovascular imaging modality when the initial vascular imaging revealed nondiagnostic findings.
The diagnosis of arterial dissection requires a high index of suspicion and consideration for detailed neurovascular imaging, including both the cranial and cervical regions. Neurovascular imaging challenges, especially visualization of arterial abnormalities, highlight the importance of appropriate and timely use of specific neurovascular imaging techniques. Magnetic resonance imaging appears to be the preferred neurovascular imaging modality in children with arterial dissection and may obviate the need for invasive cerebral catheter angiography.</description><subject>Adolescent</subject><subject>Aneurysm, Dissecting - diagnostic imaging</subject><subject>Aneurysm, Dissecting - therapy</subject><subject>Arterial imaging</subject><subject>Cerebral Angiography - methods</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Disease Management</subject><subject>Dissection</subject><subject>Humans</subject><subject>Infant</subject><subject>Intracranial Aneurysm - diagnostic imaging</subject><subject>Intracranial Aneurysm - therapy</subject><subject>Pathophysiology</subject><subject>Stroke</subject><issn>0887-8994</issn><issn>1873-5150</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkMtOwzAQRS0EgvL4BRSJDZuEsWM3NqxQKQ-J1wLWluNMqavULnaK1L8nVQsSO1Yzi3PvaA4hZxQKCnR4MSsW2DjTRY_LGNqCAVUF0AIY7JABlVWZCypglwxAyiqXSvEDcpjSDACEYnyfHJSghFCKDcjzKBrvgsX45axps-vYYXT9cuNSQtu54DPns9HUtU1Ef5m9mm4aFtNVcqENH6vM-CZ7Mt584Bx9d0z2JqZNeLKdR-T9dvw2us8fX-4eRtePuS1l2eWWWTusattILqSyDEszMRMpZVPzITfMUKgZ53VdmZpbxSlUgnGDtB42aJGWR-R807uI4XOJqdNzlyy2rfEYlkkzBqJPKbFGrzaojSGliBO9iG5u4kpT0Guheqb_CNVroRqo7oX26dPtoWU9x-Y3-2OwB8YbAPt3vxxGnaxDb_vG2PvTTXD_OvQN7JiQvA</recordid><startdate>201906</startdate><enddate>201906</enddate><creator>Nash, Monica</creator><creator>Rafay, Mubeen F.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201906</creationdate><title>Craniocervical Arterial Dissection in Children: Pathophysiology and Management</title><author>Nash, Monica ; Rafay, Mubeen F.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c383t-c2cc67bcd84589c2e3afaf888db464a2a10b244bb7ab4c94107524ae1b6dece13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adolescent</topic><topic>Aneurysm, Dissecting - diagnostic imaging</topic><topic>Aneurysm, Dissecting - therapy</topic><topic>Arterial imaging</topic><topic>Cerebral Angiography - methods</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Disease Management</topic><topic>Dissection</topic><topic>Humans</topic><topic>Infant</topic><topic>Intracranial Aneurysm - diagnostic imaging</topic><topic>Intracranial Aneurysm - therapy</topic><topic>Pathophysiology</topic><topic>Stroke</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Nash, Monica</creatorcontrib><creatorcontrib>Rafay, Mubeen F.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Pediatric neurology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nash, Monica</au><au>Rafay, Mubeen F.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Craniocervical Arterial Dissection in Children: Pathophysiology and Management</atitle><jtitle>Pediatric neurology</jtitle><addtitle>Pediatr Neurol</addtitle><date>2019-06</date><risdate>2019</risdate><volume>95</volume><spage>9</spage><epage>18</epage><pages>9-18</pages><issn>0887-8994</issn><eissn>1873-5150</eissn><abstract>Craniocervical arterial dissection is a commonly reported arteriopathy associated with stroke in children. It is characterized by a high stroke recurrence rate and variable outcomes. Here we review the pathophysiology, clinical presentation, and diagnostic neuroimaging approaches that are helpful in accurate diagnosis and follow-up of children with arterial dissection.
MEDLINE searches (2000 to 2018) for articles that contained patients aged less than 18 years with craniocervical arterial dissection was performed, with the goal of analyzing their presenting features, pathophysiological mechanisms, and imaging characteristics and interventions.
Sixteen articles met the study criteria and reported 182 cases of craniocervical arterial dissection, 68% male, average age 8.6 years. Dissection was associated with head and neck trauma in 56% of the cases and frequently involved the posterior (61%) and extracranial locations (64%); the vertebral artery was the most commonly involved artery (60%). The most common clinical presentation was hemiparesis (80/160, 50%), followed by headache (64/164, 39%). Magnetic resonance imaging was the preferred neuroimaging method, followed by cerebral catheter angiography as a gold standard definitive neurovascular imaging modality when the initial vascular imaging revealed nondiagnostic findings.
The diagnosis of arterial dissection requires a high index of suspicion and consideration for detailed neurovascular imaging, including both the cranial and cervical regions. Neurovascular imaging challenges, especially visualization of arterial abnormalities, highlight the importance of appropriate and timely use of specific neurovascular imaging techniques. Magnetic resonance imaging appears to be the preferred neurovascular imaging modality in children with arterial dissection and may obviate the need for invasive cerebral catheter angiography.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>30955992</pmid><doi>10.1016/j.pediatrneurol.2019.01.020</doi><tpages>10</tpages></addata></record> |
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subjects | Adolescent Aneurysm, Dissecting - diagnostic imaging Aneurysm, Dissecting - therapy Arterial imaging Cerebral Angiography - methods Child Child, Preschool Disease Management Dissection Humans Infant Intracranial Aneurysm - diagnostic imaging Intracranial Aneurysm - therapy Pathophysiology Stroke |
title | Craniocervical Arterial Dissection in Children: Pathophysiology and Management |
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