Vertebral artery dissection aneurysm in a pediatric patient: A rare case with unusual clinical manifestations, diagnostic, and management challenges

Author:

Oshi Mohammed A. M.12ORCID,Aljabri Mohammed Fahad2,Alotaibi Saad3,Alzahrani Yahea4,Alfaifi Jaber5,Abosabie Salma A. S.6,Abosabie Sara A.7,Algethami Samaher S.8,Younes Alaa E.9,Almanjoomi Raid K.8,Babkour, Bashar3,Kamal Naglaa M.10

Affiliation:

1. Neurology Division, Gaafar Ibnauf Children’s Emergency Hospital, Khartoum, Sudan

2. Alhada Armed Forces Hospital, Department of Pediatrics, Neurology Division, Taif, Kingdom of Saudi Arabia

3. Department of Radiology, Neuroradiology Section, Alhada Armed Forces Hospital, Taif, Kingdom of Saudi Arabia

4. Department of Radiology, Faculty of Medicine, Taif University, Taif, Kingdom of Saudi Arabia

5. Department of Child Health, College of Medicine, University of Bisha, Bisha, Saudi Arabia

6. Faculty of Medicine, Julius-Maximilians-Universität Würzburg, Bavaria, Germany

7. Faculty of Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany

8. Taif Children Hospital, Taif, KSA

9. Department of Surgery, College of Medicine, Taif University, Taif, Saudi Arabia

10. Pediatrics and Pediatric Hepatology, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt.

Abstract

Vertebral artery aneurysm is a rare condition with diverse clinical manifestations in pediatric patients. We present the case of a 12-year-old male who presented with diplopia, vomiting, ataxia, and severe headache. Diagnostic evaluation revealed an extracranial vertebral artery dissection with an associated aneurysm at the C3–C4 level. Despite the absence of recurrent ischemic strokes, the aneurysm posed challenges in differentiating the symptoms from other inflammatory demyelinating disorders, particularly internuclear ophthalmoplegia. Diagnosis relied on a thorough history, physical examination, and imaging studies. Magnetic resonance imaging with magnetic resonance angiography confirmed the diagnosis and played a crucial role in assessing the size, location, and extent of the aneurysm. Additionally, the imaging findings helped guide treatment decisions and determine the need for anticoagulation therapy. Regular follow-up imaging was initiated to monitor for late complications and evaluate the effectiveness of the management approach. This case highlights the atypical presentation of vertebral artery aneurysm in a pediatric patient, underscoring the importance of clinical suspicion and the role of advanced imaging techniques in facilitating accurate diagnosis and guiding appropriate management. Prompt diagnosis and optimal utilization of imaging modalities are essential in preventing severe morbidity and mortality. Further research is warranted to enhance our understanding of this condition and refine imaging and management protocols in pediatric population.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

General Medicine

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