To discuss a rare case of basilar artery dissection (“BAD”) in a pediatric patient.

BAD is an uncommon and potentially catastrophic vascular event characterized by a tear in the inner lining of the basilar artery and is exceptionally rare in pediatric populations. This often presents a diagnostic and therapeutic challenge for clinicians given the limited available literature and guidelines. We present a unique case of BAD in the youngest child reported, exploring the diagnostic journey, management strategies, and subsequent outcomes, thereby contributing to the sparse data available on pediatric cerebrovascular events.

Detailed chart review and literature search.

A 5-year-old M presented with multiple days of headache and altered vision without history of trauma or illness. Initial NIHSS was 3, and CTA revealed BAD. The patient was not a candidate for acute thrombolytic therapy due to duration of symptoms. MRI confirmed acute ischemic stroke in bilateral PCA and PICA territories and MRA confirmed right PCA occlusion. Patient was initiated on anticoagulation with a heparin infusion. Repeat MRA showed a new left PCA occlusion and MRI showed new bilateral cerebellar and ACA/MCA infracts. Conventional angiogram confirmed multifocal occlusions and dissections. Extensive workup with hematology, rheumatology and genetics was unrevealing for definitive etiology for strokes. The patient was discharged on enoxaparin injections, returning several days later with worsening headache. Repeat MRI revealed a new right lateral PICA infract. Clinically he remained stable. Ultimately, he was again discharged on enoxaparin with the addition of aspirin; he has had no further infracts on follow-up imaging.

This case describes the youngest reported patient with BAD and associate infracts. This case reinforces the need for wide range of imaging in pediatric stroke. Given the rarity of pediatric BAD, this case adds to the limited literature on the best treatment and the roles for medical and surgical management.