J Korean Child Neurol Soc.  2017 Mar;25(1):48-53. 10.0000/jkcns.2017.25.1.48.

A Case of Spontaneous Internal Carotid Artery Dissection Presenting as a Seizure without Focal Neurologic Signs

• Lee SY
• Park J
• Lee MS
• Lee KY

• KMID: 2385214
• DOI: http://doi.org/10.0000/jkcns.2017.25.1.48

Abstract

Craniocervical artery dissection is an uncommon cause of acute ischemic stroke in children, although it is an important cause of stroke in young and middle-aged patients. Among craniocervical artery dissection, internal carotid artery (ICA) dissection usually presents with focal neurologic deficits, such as acute hemiparesis. However, if it presents with only non-localizing signs, such as headache and seizure, ICA dissection may be overlooked in a differential diagnosis. Here we describe an 8-year-old boy who had spontaneous internal carotid artery dissection presenting as a seizure without focal neurologic signs. The patient was admitted to the emergency department because of seizure. On arrival at the emergency department, focal neurologic signs, such as motor weakness, were not observed. The patient had no recent trauma history. Magnetic resonance imaging revealed diffusion-restriction in the left basal ganglia. Magnetic resonance angiography, computed tomography angiography, and cerebral angiography demonstrated occlusion of the left distal ICA with tapered stenosis (so-called "string sign"). The patient was treated with aspirin and oxcarbazepine to prevent thrombosis and further seizures. Three-month follow-up MRA revealed apparent improvement of the occlusion of the left distal internal carotid artery. The patient had no neurologic deficits or further seizures in the outpatient clinic 13 months after discharge. This case demonstrated that acute ischemic stroke resulting from ICA dissection can occur with seizures without focal neurologic signs. In addition, ICA dissection should be considered as a possible cause of acute ischemic stroke even in children with no history of trauma.

Keyword

Internal carotid artery dissection; Seizures; Neurologic manifestations; Child

MeSH Terms

Ambulatory Care Facilities
Angiography
Arteries
Aspirin
Basal Ganglia
Carotid Artery, Internal*
Carotid Artery, Internal, Dissection*
Cerebral Angiography
Child
Constriction, Pathologic
Diagnosis, Differential
Emergency Service, Hospital
Follow-Up Studies
Headache
Humans
Magnetic Resonance Angiography
Magnetic Resonance Imaging
Male
Neurologic Manifestations*
Paresis
Seizures*
Stroke
Thrombosis
Aspirin