Dissecting vertebrobasilar aneurysm in a child
Dissecting vertebrobasilar aneurysm in a child
Introduction: Paediatric intracranial aneurysms are rare. The pattern of disease is different to that in adults and there is far less literature available. I provide a case as an example of the presentation and progress of a child with a dissecting vertebrobasilar artery aneurysm. Presentation: 11-year-old boy presented to his local hospital with sudden-onset headache, photophobia and vomiting. Bloods and observations were normal - discharged. Symptoms recurred more severely the following day. Managed as meningitis. 4 lumbar punctures were 'bloody' and considered failed. MRI brain 2 days post-admission demonstrated a vertebrobasilar aneurysm. Transferred to the regional Neurosurgical centre. Transfer to Neurosurgical/Neurovascular centre: Cerebral angiography revealed dissecting vertebrobasilar aneurysm (1298910mm). Fusiform component extending beyond AICI/ PICA origins. Wide-necked saccular component. Procedure and progress: Loaded with Aspirin and Clopidogrel. Underwent endovascular procedure the following day - coil embolization, flow-diverting stent to the aneurysm. Ongoing low dose dual anti-platelet therapy. Made an excellent recovery with no neurological deficits. Further imaging - X-ray cervical spine for possible arcuate foramen or atlantoaxial instability, normal. Ultrasound liver/spleen, normal. Discharged home 10 days post-transfer. Patient background: Past medical history - under the GP for 18 months of headaches. Trauma - significant fall from bicycle 2 years before with forced lateral flexion of the neck. Posited that this may have been a contributing factor in aneurysm development. No significant family history. Lifestyle - an active boy, enjoys weightlifting and motocross. Weightlifting also posited as a contributing factor. Conclusions: I provide a case which I hope will raise awareness of paediatric intracranial aneurysms and stimulate discussion concerning their management and aetiology.
X ray, acetylsalicylic acid, awareness, bicycle, brain angiography, case report, cervical spine, child, clinical article, clopidogrel, coil embolization, conference abstract, dual antiplatelet therapy, endovascular surgery, family history, headache, human, injury, intracranial aneurysm, lifestyle, liver, low drug dose, lumbar puncture, male, meningitis, motocross, nuclear magnetic resonance imaging, photophobia, school child, spleen, ultrasound, vomiting
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Greenbury, C
4164603a-0d72-4b4f-9e5b-1712b30b4626
Kirkham, F
1dfbc0d5-aebe-4439-9fb2-dac6503bcd58
January 2020
Greenbury, C
4164603a-0d72-4b4f-9e5b-1712b30b4626
Kirkham, F
1dfbc0d5-aebe-4439-9fb2-dac6503bcd58
Greenbury, C and Kirkham, F
(2020)
Dissecting vertebrobasilar aneurysm in a child.
Developmental Medicine and Child Neurology, 62 (S1), , [69].
(doi:10.1111/dmcn.14411).
Record type:
Meeting abstract
Abstract
Introduction: Paediatric intracranial aneurysms are rare. The pattern of disease is different to that in adults and there is far less literature available. I provide a case as an example of the presentation and progress of a child with a dissecting vertebrobasilar artery aneurysm. Presentation: 11-year-old boy presented to his local hospital with sudden-onset headache, photophobia and vomiting. Bloods and observations were normal - discharged. Symptoms recurred more severely the following day. Managed as meningitis. 4 lumbar punctures were 'bloody' and considered failed. MRI brain 2 days post-admission demonstrated a vertebrobasilar aneurysm. Transferred to the regional Neurosurgical centre. Transfer to Neurosurgical/Neurovascular centre: Cerebral angiography revealed dissecting vertebrobasilar aneurysm (1298910mm). Fusiform component extending beyond AICI/ PICA origins. Wide-necked saccular component. Procedure and progress: Loaded with Aspirin and Clopidogrel. Underwent endovascular procedure the following day - coil embolization, flow-diverting stent to the aneurysm. Ongoing low dose dual anti-platelet therapy. Made an excellent recovery with no neurological deficits. Further imaging - X-ray cervical spine for possible arcuate foramen or atlantoaxial instability, normal. Ultrasound liver/spleen, normal. Discharged home 10 days post-transfer. Patient background: Past medical history - under the GP for 18 months of headaches. Trauma - significant fall from bicycle 2 years before with forced lateral flexion of the neck. Posited that this may have been a contributing factor in aneurysm development. No significant family history. Lifestyle - an active boy, enjoys weightlifting and motocross. Weightlifting also posited as a contributing factor. Conclusions: I provide a case which I hope will raise awareness of paediatric intracranial aneurysms and stimulate discussion concerning their management and aetiology.
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e-pub ahead of print date: 10 January 2020
Published date: January 2020
Keywords:
X ray, acetylsalicylic acid, awareness, bicycle, brain angiography, case report, cervical spine, child, clinical article, clopidogrel, coil embolization, conference abstract, dual antiplatelet therapy, endovascular surgery, family history, headache, human, injury, intracranial aneurysm, lifestyle, liver, low drug dose, lumbar puncture, male, meningitis, motocross, nuclear magnetic resonance imaging, photophobia, school child, spleen, ultrasound, vomiting
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Local EPrints ID: 446056
URI: http://eprints.soton.ac.uk/id/eprint/446056
ISSN: 0012-1622
PURE UUID: 5fdb2c2e-c45b-48c8-9a1a-ae4e22a06981
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Date deposited: 19 Jan 2021 17:34
Last modified: 17 Mar 2024 02:53
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C Greenbury
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