Background: Dissection of the walls of the cervical and cerebral arteries is rare in childhood.
Case report: A 6 year-old girl suddenly suffered a loss of consciousness followed by a generalized tonic-clonic seizure 90 min after a non-traumatic fall. At admission, she had a massive right hemiplegia with aphasia. The CSF was not hemorrhagic. A CT-scan performed at H3 without infusion of radiopaque contrast material was normal, but a second CT-scan on day 4 showed a low density in the low area of the middle cerebral artery. An arteriogram taken on day 6 showed that the wall of the proximal part of this artery was irregular, with a discrete additive imaging. The child was treated with IV heparin for 3 weeks, then with aspirin. All investigations for the possible cause of thrombosis (protein C and S, antithrombin III, homocystinuria, etc...) were negative. Two further arteriograms, the last after a follow-up of 16 months, showed progressive disappearance of the wall irregularities and replacement of the additive imaging by a large aneurysm, suggesting a dissection. The hemiplegia persists under prolonged aspirin therapy.
Conclusion: This case shows that dissection may occur in childhood without any apparent cause. It can result in the development of an aneurysm, a complication which is more frequent following dissection of the cervical rather the cerebral arteries.