Occult posterior inferior cerebellar artery dissection requiring endovascular treatment following pediatric head trauma: case report

• Published in: Journal of neurosurgery. Pediatrics Vol. 27; no. 6; p. 643
• Main Authors: Grover, Patrick J, Harris, Lauren, Qureshi, Ayman M, Rennie, Adam, Robertson, Fergus, James, Greg
• Format: Journal Article
• Language: English
• Published: United States 01.06.2021
• Subjects: Adolescent; Aneurysm, Ruptured - diagnostic imaging; Aneurysm, Ruptured - therapy; Aortic Dissection; Brain Injuries, Traumatic; Cerebral Arteries - diagnostic imaging; Cerebral Arteries - pathology; Cerebral Arteries - surgery; Embolization, Therapeutic - methods; Endovascular Procedures - methods; Humans; Intracranial Aneurysm - diagnostic imaging; Intracranial Aneurysm - therapy; Intracranial Hemorrhages - diagnostic imaging; Intracranial Hemorrhages - etiology; Male; Tomography, X-Ray Computed; trauma; aneurysm; PICA; pediatrics; posterior inferior cerebellar artery; vascular disorders; dissection
• ISSN: 1933-0715
• DOI: 10.3171/2020.11.PEDS18324

This is the eighth case report of a pediatric dissecting posterior inferior cerebellar artery aneurysm. The authors present the case of a 13-year-old boy who presented with posttraumatic posterior fossa subdural, subarachnoid, and intraventricular hemorrhage with hydrocephalus. Initial vascular imaging findings were negative; however, a high level of suspicion is necessary. The aneurysm was identified on day 20, after recurrence of hydrocephalus, and was treated with endovascular vessel sacrifice. The patient made a good recovery. It is important to consider arterial dissection in pediatric traumatic brain injury, especially with suspicious findings on initial CT scan and clinical presentation out of proportion to the mechanism of injury. Delayed vascular imaging is imperative for appropriate management.