Abstract
A 10-year-old boy was hospitalized with post-traumatic nausea, vomiting, and ataxia. A cervical X-ray showed atlantoaxial dislocation with os odontoideum, and a computed tomography scan revealed multiple cerebellar infarctions. Cerebral angiography disclosed right vertebral artery occlusion at the craniovertebral junction and basilar artery occlusion distal to the origin of the anterior inferior cerebellar artery. An intra-arterial thrombus was present in the left vertebral artery just above the transverse foramen of os axis. Sequential cerebral angiography showed persistent occlusion of the right vertebral and basilar arteries. However, within 1 month of the injury, the thrombus in the vertebral artery had disappeared and an aneurysmal dilatation had appeared at the same site. The patient underwent posterior fusion of the atlas and axis, and his recovery was uneventful. Aneurysmal dilatation disappeared spontaneously 4 months after the trauma. In this case, atlantoaxial dislocation might have caused the left vertebral artery thrombosis and resulted in the basilar artery occlusion. The authors discuss 38 previously reported cases of vertebrobasilar arterial occlusion in children and emphasize that, in children, the vertebral artery is vulnerable at the atlantoaxial level.
