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

Patrick J Grover MA, MSc, FRCS1, Lauren Harris MBBS1, Ayman M Qureshi MBChB, MMed, FRCR1, Adam Rennie MBBS, FRCR2, Fergus Robertson MA, MD, FRCR2, and Greg James PhD, FRCS2
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  • 1 Department of Neurosurgery, National Hospital for Neurology and Neurosurgery; and
  • | 2 Department of Neurosurgery, Great Ormond Street Hospital, London, United Kingdom
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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.

ABBREVIATIONS

EVD = external ventricular drain; GCS = Glasgow Coma Scale; PICA = posterior inferior cerebellar artery; VP = ventriculoperitoneal.

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Contributor Notes

Correspondence Patrick J. Grover: National Hospital for Neurology and Neurosurgery, London, United Kingdom. p.grover@nhs.net.

INCLUDE WHEN CITING Published online April 09, 2021; DOI: 10.3171/2020.11.PEDS18324.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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