Rare Cause of Cerebellar Mutism in Childhood: Vertebral Artery Dissection

Abstract

Vertebral artery dissection (VAD), an extremely rare childhood disorder, constitutes 2%-3% of cerebrovascular diseases (CVDs). The annual incidence of CVD in childhood is estimated to be 3-8 per 100.000. Although it is generally observed after trauma, it could also be observed simultaneously with trauma. CVD is diagnosed by cranial magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA). However, the gold standard for CVD diagnosis is conventional angiography. A 12-years-old girl presenting with symptoms of headache and vomiting lasting for 5 days was hospitalized and followed up. In the neurological examination, muscle power in lower and upper extremes was 4/5 on the right and 2/5 on the left, while Babinski response was extensor on the
left. Cranial MRA revealed a dissection in the right middle vertebral artery at the M1 segment, with vascular irregularity. Warfarin sodium was administered to the patient based on recommendation, and physical therapy was also started. Moderate recovery was observed in aphasia, and partial recovery was observed in left hemiplegia after 7 days of treatment. Cerebellar infarct and cerebellar mutism cases should be investigated for VAD. Early diagnosis and treatment are very pertinent for reduction of mortality and morbidity due to the disease. Angiography should be performed for diagnosis.