A girl, aged 9 years, with cerebellar infarction following minor neck injury sustained while ice-skating is reported from West Virginia University, Morgantown, WV. Symptoms began 12 hours after the fall, with vomiting that awakened her from sleep and recurred hourly. She complained of a throbbing occipital headache, stiff neck, photophobia, dizziness on standing, and ataxia. She had horizontal nystagmus, dysmetria bilaterally, and she stood and walked only with support. CT and MRI revealed a cerebellar vermian lesion extending into both hemispheres. Posterior fossa decompression and biopsy showed coagulative necrosis and no neoplasm. Vertebral angiography revealed a traumatic aneurysm within the distal right cervical vertebral artery and recanalization of an embolus in the right posterior inferior cerebellar artery with a narrowed lumen. She was treated with aspirin and recovery was complete after 3 months, with no recurrence at 1 year follow-up. [1]
COMMENT. Childhood traumatic vertebral artery stroke was previously thought to affect boys only [2]. With the increased participation of girls in contact sports, more female cases may be expected.
A further case of vertebral-artery dissection occurring in an 11-year-old boy following a judo session is reported from Besancon, France [3]. CT showed a left thalamic infarct, and angiography revealed fibromuscular dysplasia ("string of beads” lesion) of the left vertebral artery with probable dissection. With anticoagulation, bed rest, and a cervical soft collar, symptoms of headaches, vomiting, left ptosis and diplopia, dysphasia, and ataxia resolved, and the boy was discharged taking aspirin after 2 weeks.