Vertebral Artery Dissection Masquerading as Concussion in an Adolescent.
Pediatr Emerg Care. 2018 Could;34(5):e97-e99
Authors: Kumar G, Ludwig B, Patel VV
OBJECTIVE: Educate suppliers concerning the scientific presentation and penalties of delaying analysis of traumatic vertebral artery dissection with thromboembolic ischemic strokes within the pediatric inhabitants. Vertebral artery dissection is usually troublesome to diagnose and generally is a probably devastating reason for ischemic stroke.
METHODS: Assessment of the chart, peer evaluation/dialogue, and imaging interpretation.
RESULTS: A 16-year-old boy was admitted with confusion after a head and neck trauma was sustained whereas wrestling. (Glasgow Coma Scale=15, NIHSS = zero). Investigations together with computed tomography (CT) head and cervical backbone had been regular. He then developed extreme nausea, vomiting, dizziness, and complications and was admitted for signs of concussion. Ten hours later, affected person declined (hypertensive and unresponsive) and was famous to have decerebrate posturing. After emergent intubation, he was transferred to the pediatric intensive care unit. Repeat CT head confirmed an acute left cerebellar infarct with related cerebellar edema leading to effacement of the fourth ventricle/basilar cisterns and acute hydrocephalus. The CT angiography and magnetic resonance imaging of mind confirmed arterial dissection and close to occlusion of the left vertebral artery on the C2 stage. In depth infarct was seen within the left cerebellum, brainstem, and proper cerebellum. Throughout a chronic hospital keep, the household opted to proceed care, and he was transferred to an inpatient rehabilitation facility due to restricted brainstem exercise, being nonverbal, and never demonstrating purposeful spontaneous actions.
CONCLUSIONS: Detailed historical past and thorough neurological examination along side acceptable imaging are obligatory to differentiate between brainstem/cerebellar ischemia from vertebral artery dissection and concussion.
PMID: 29718002 [PubMed – in process]