Stroke Recurrence in Children with Vertebral Artery Dissecting Aneurysm

A 3-year-old boy initially presenting with syncope. A, Axial DWI demonstrates multiple areas of diffusion restriction in the posterior circulation. Abnormalities were bilateral and of differing signal intensity on ADC maps, implying different ages (not shown). B, Axial CTA image from the same day as image A shows focal dilation of the left V3 proximal segment (white arrow). This abnormality was not diagnosed at the time of imaging. C, Repeat DWI 3 weeks after initial presentation following new neurologic symptoms while on aspirin demonstrates a new area of restricted diffusion in the left superior cerebellum. D, Conventional angiography, performed 2 days after image C, demonstrates the focal area of left proximal V3 segment dilation and irregularity (black arrow). This abnormality was only present on a single series due to a misalignment of the lateral camera of the biplane, and it was not diagnosed at the time of the procedure. E, Axial DWI obtained 8 weeks after initial presentation following another acute neurologic deterioration while on anticoagulation demonstrates a new area of diffusion restriction in the left thalamus (white arrow). F, Catheter angiogram demonstrates complete coil occlusion of the abnormal vertebral artery segment. No recurrent symptoms or new areas of infarction occurred following this procedure.