Lesson of the Week: Carotid dissection causing stroke in a child with migraine

摘要

The aetiology of stroke in childhood and adolescence often remains obscure. Up to 50% of published cases are said to be idiopathic, but often the search for an underlying cause is not exhaustive. Arterial dissection, usually of the internal carotid artery, is an important cause of stroke in this age group, accounting for 6% of cases in our series of 115 patients (unpublished data). Migrainous infarction, on the other hand, is rare in all ages and should be a diagnosis of exclusion. Unfortunately, in a patient with a history of headache it is often tempting to make this diagnosis. This case shows that other, potentially treatable, disease may be missed as a consequence.