Three boys, ages 11, 8, and 7 years, with strokes from vertebral artery lesions resulting from neck trauma are reported from Indiana University School of Medicine, Indianapolis, and Baylor College of Medicine, Houston, TX. The 11 year-old woke with left-leg ataxia and sore neck, the morning after being tackled at a football game. He had continued playing to finish the game. Brain stem and cerebellar signs, including left exotropia with nystagmus, impaired adduction of the left eye in convergence, and deviation to the left in compass gait test, were explained by a linear filling defect of the left vertebral artery at C1-2 level consistent with intimal dissection, documented by a 4-vessel cerebral arteriogram. CT and brain and cervical spine MRIs were normal. He recovered rapidly and was discharged to take one aspirin daily and avoid contact sports. The 8-year-old also recovered after minor neck trauma followed by recurrent episodes of ataxia, hemiparesis, and visual field defect with left VA thrombus at C-2 and multiple emboli in posterior cerebral arteries. The 7-year-old sustained a traumatic pseudoaneurysm with persistent hemiparesis and ataxia. Clinical data are summarized of 16 cases culled from the literature. [1]
COMMENT. Fortunately, the prognosis for survival in vertebral artery stroke in children is generally excellent. Only one of 19 patients died. Two had residual quadriplegia, 9 had mild to moderate residual hemiparesis, ataxia, and/or dysarthria, and 7 (37%) recovered.