Investig Magn Reson Imaging.  2019 Sep;23(3):259-263. 10.13104/imri.2019.23.3.259.

Spontaneous Intracranial Vertebral Artery Dissection in a 2-Year-Old Child Diagnosed with High-Resolution MRI: a Case Report

• Heo S
• Han M
• Kim SH
• Choi JW

• KMID: 2459880
• DOI: http://doi.org/10.13104/imri.2019.23.3.259

Abstract

Although many imaging modalities can play some roles in the diagnosis of vertebral artery dissection (VAD), digital subtraction angiography (DSA) remains the gold standard method, with the highest detection rate and ability to assist in planning for endovascular treatment. However, this tool is often avoided in children because its invasive nature and it exposes them to radiation. High resolution magnetic resonance imaging (HR-MRI) have been suggested to be a reliable and non-invasive alternative, but it has never been discussed in children in whom vertebral artery dissection is a rare condition. In this report, we evaluate a case of a 2-year-old child who initially presented with cerebellar symptoms, and was early diagnosed with vertebral artery dissection using HR-MRI and was successfully treated.

Keyword

Vertebral artery dissection; High resolution MRI; Child

MeSH Terms

Angiography, Digital Subtraction
Child*
Child, Preschool*
Diagnosis
Humans
Magnetic Resonance Imaging*
Methods
Vertebral Artery Dissection*
Vertebral Artery*

Figure

• 

  Fig. 1 A 2-year-old boy underwent CT and MRI due to sudden onset of irritability, vomiting and gait disturbance. Focal low density (arrows) is noted at cerebellar vermis on the initial CT scan (a) and diffusion restriction foci (dashed arrows) are observed at the corresponding cerebellar vermis and additionally at posterior inferior cerebellar artery (PICA) territory on DWI (b). On the MRA, the left vertebral artery flow is not seen and sharp distal edge is observed (c, arrowheads)

• 

  Fig. 2 High resolution MRI (HR-MRI) was performed 5 days later after the onset of the symptoms to confirm the vertebral artery dissection. The dilatation of the outer wall (dashed line) at occluded left vertebral artery segment on MRA is seen on T2WI (a) of HR-MRI. The dissection flap (arrows points to both ends of flap on each slice) is also evident on serial T2WIs (from left to right in figure show cranio-caudal slices). The mural hematoma (arrowheads) in early subacute stage is detectable as high signal intensity lesion on not only T1WI (b) but also contrast enhanced (CE)-T1WI (c) at medial side of double lumen. The dissection flap is also enhanced linearly (arrow) on CE-T1WI.

• 

  Fig. 3 Follow up HR-MRI was performed 3-months later. Normalized vascular flow (arrows) and contour (thick dashed lines) of left vertebral artery are seen on MRA (a), HR-T2WI (b) and T1WI (c). The dissection flap and hematoma are no longer visible. The left PICA artery flow (dashed arrows) and vascular contour (thin dashed line, thin dashed circle indicates the origin of left PICA from vertebral artery) are also newly observed on follow up images.

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