Objective:

To present a rare case of pediatric stroke secondary to vertebral artery compression caused by a dysmorphic C1 lateral mass.

Background:

Pediatric stroke is uncommon, and etiologies can often be elusive. We report a case of a 14-year-old male who developed an acute cerebellar infarction and subacute occipital infarction, secondary to vertebral artery compression from an anatomical abnormality.

Design/Methods:

A 14-year-old male with no significant past medical history presented to the emergency department with acute vertigo, vomiting, and persistent visual symptoms following a football game. He had been diagnosed with migraines with aura two weeks prior, reporting persistent visual disturbances in the superior right visual fields since the onset of migraine headache and intermittent central scotomas before the onset of headaches. On presentation, the physical exam was notable only for right superior quadrantanopia. 

Results:

 Initial laboratory studies, including CBC, CMP, magnesium, phosphorus, and urine drug screen, were unremarkable. Brain MRI revealed acute infarcts in the left cerebellar hemisphere and subacute infarcts in the left temporal lobe, explaining the visual deficits and vertigo. A CT angiogram of the head and neck showed a dysmorphic left lateral mass of C1 causing significant compression and kinking of the V3 segment of the left vertebral artery, with possible pseudoaneurysm formation. A hypercoagulable workup and transthoracic echocardiogram with bubble study were negative. The stroke was attributed to vertebral artery compression from a bony C1 anomaly. The patient was treated with a rigid cervical collar and therapeutic enoxaparin and discharged home with plans for digital subtraction angiography and neurosurgical evaluation to assess for Bow Hunter’s Syndrome.

Conclusions: