An unusual cause of pediatric stroke secondary to congenital basilar artery fenestration

J J Gold; J R Crawford

doi:10.1155/2013/627972

An unusual cause of pediatric stroke secondary to congenital basilar artery fenestration

Case Rep Crit Care. 2013:2013:627972. doi: 10.1155/2013/627972. Epub 2013 Jan 17.

Authors

J J Gold¹, J R Crawford²

Affiliations

¹ Division of Child Neurology, Department of Neurosciences, Rady Children's Hospital-San Diego and University of California, 8010 Frost Street Suite 400, San Diego, CA 92123, USA.
² Division of Child Neurology, Department of Neurosciences, Rady Children's Hospital-San Diego and University of California, 8010 Frost Street Suite 400, San Diego, CA 92123, USA ; Department of Pediatrics, Rady Children's Hospital-San Diego and University of California, San Diego, CA 92123, USA.

Abstract

Basilar artery fenestration is an uncommon congenital variant that has been associated with aneurysms and posterior circulation infarcts in the adult literature. Little is known about the functional consequences of basilar artery fenestration, if any, in childhood. We present a case of a previously healthy 12-year-old boy who presented with diplopia, tinnitus, and ataxia who had subtle findings on diffusion-weighted magnetic resonance imaging consistent with posterior circulation territory infarction. Computed tomography angiography and magnetic resonance angiography revealed an area of signal abnormality in the basilar artery, which was confirmed on conventional angiography to be a type 2 basilar artery fenestration, without thrombus or aneurysm. The patient recovered from his neurologic deficits over two days and was placed on prophylactic aspirin therapy without recurrence of symptoms. This rare anatomic variant of the posterior circulation is important for physicians to recognize and may have associated neurologic consequences during childhood worthy of further investigation.