Abstract Details

Title Bow Hunter’s Syndrome Secondary to Dysmorphic C1 Lateral Mass Compressing Vertebral Artery: A Case of Acute and Subacute Stroke in a Pediatric Patient

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P1 - Poster Session 1 (11:45 AM-12:45 PM)

Poster/Presentation
Number 14-008

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

This case highlights the importance of considering structural abnormalities in pediatric stroke. Vertebral artery compression from a dysmorphic C1 lateral mass is an uncommon but significant cause of stroke that warrants further evaluation in similar cases.

Authors/Disclosures
Eun Hye Kim, MD (Mayo Clinic) PRESENTER	Dr. Lee has stock in Pacific biosciences.
Brian L. Appavu, MD (Phoenix Children's Hospital)	Dr. Appavu has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for Natus. The institution of Dr. Appavu has received research support from American Heart Association. The institution of Dr. Appavu has received research support from United States Department of Defense.

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