Pediatric arterial dissection

What is a pediatric arterial dissection?

An arterial dissection is a tear in the inside lining of an artery in the head or neck that supplies blood flow to the brain. In children, arterial dissections are most commonly due to trauma. 

This is a rare condition, but when it does occur, it can narrow or block blood flow to the brain, causing a stroke or permanent loss of brain function.

The Center for Cerebrovascular Disorders in Children is among the very best in the region at performing the most advanced procedures and therapies for the treatment of pediatric cerebrovascular disease. Each of our primary team members works solely in the pediatric setting with a clinical interest in disorders of the cerebrovascular system.

This program is the only one of its kind in Texas, and one of a handful across the nation. It offers a unique level of expertise in the management and treatment of patients with arterial dissections specific to children and adolescents. We are the only program in Dallas to offer pediatric neurosurgery and neuro-radiology coverage 24 hours a day by specialized, dedicated pediatric providers.

When treating a child with an arterial dissection, the cerebrovascular team collaborates with hematology and our trauma team to ensure the treatment plan is tailored to meet the individual needs of each patient.

Please email ccdc@childrens.com to schedule an appointment.

What are the signs and symptoms of a pediatric arterial dissection?

The symptoms of an arterial dissection in children mirror those of a stroke, and can include:

• Seizures

• Sudden speech changes, such as slurring or jumbled speech

• Sudden partial or complete loss of sensation or movement on one side of the body

• Weakness on one side of the body

• Neck pain or headache

• Sudden partial or complete blindness

How is a pediatric arterial dissection diagnosed?

The majority of children with an arterial dissection experience symptoms similar to a stroke. If those symptoms are evident, it is important your child be evaluated for both a stroke and an arterial dissection.

Tests commonly used to diagnose an arterial dissection include:

• MRI with magnetic resonance Angiography (MRA) - This procedure uses  radiofrequency to create accurate two- and three-dimensional images of the arteries in the neck and brain.

• Cerebral angiogram - This test is performed by an interventional radiologist who specializes in the care of children. This is extremely important as children have smaller blood vessels, limitations on dye administration, and specific radiation recommendations.

• The cerebral angiogram is a minimally invasive procedure which uses a special contrast, or dye, to observe blood flow in the brain. During the procedure, the radiologist places a small IV or catheter in a blood vessel in the groin, which he or she then uses to reach the blood vessels that supply the brain.

• With the help of the special contrast or dye, an X-ray machine moves in different angles and takes pictures of the blood vessels. A team consisting of a radiologist, anesthesiologist, radiology technologists, and nurses will care for your child throughout the procedure.

• Following the procedure, your child will have to lie flat for approximately four hours due to puncture of a large blood vessel in the groin, as this decreases the risk of bleeding.  If needed, your child will receive medication to help him or her relax and rest during this time.

What are the causes of a pediatric arterial dissection?

Arterial dissections in children are very rare. They can be caused by head or neck trauma, or because of an underlying condition that weakens the blood vessels.

How is a pediatric arterial dissection treated?

Arterial dissections often heal in children on their own, but treatment is necessary to prevent a stroke while healing occurs.

• Medications that thin the blood or slow clotting are most often prescribed to keep the blood from forming clots that could block the arteries.

• Arterial angiography - If the tear is too severe to heal on its own, a child will typically undergo an arterial angiography, during which a stent can be placed in the artery to strengthen the area and keep it open.

• Surgery - Sometimes surgery is needed to repair the dissection.