Middle Cerebral Artery Dissection in Childhood
Nontraumatic, intracranial dissections have rarely been reported in otherwise healthy children, so documentation of such cases is helpful to promote recognition of the disorder. Three white children, aged 5, 13, and 15 years, presented with acute strokes characterized by a relapsing and remitting course over a few hours and were found to have middle cerebral artery (MCA) dissection. Headache, gait difficulty, and speech disturbance occurred abruptly during normal play and were followed by hemiplegia with aphasia or anosognosia. Systemic or cardiac disease and hematplogic disorders were excluded. Nonin-vasive studies were unremarkable. Angiography disclosed the string sign in the MCA, indicating vascular dissection which was confirmed at autopsy in one case. The surviving children showed better recovery of speech and language than sensorimotor function on follow up. Angiography remains the definitive procedure in childhood stroke. In cases of dissection affecting children* (3 above, 7 from literature), the MCA appears to be the most vulnerable intracranial vessel.
- January-February 1979 Stroke Vol 10. No 1, Page 98