Clinical Review

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

BMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7076.291 (Published 25 January 1997) Cite this as: BMJ 1997;314:291
  1. V Ganesan, research fellowa,
  2. F J Kirkham, senior lecturera
  1. a Neurosciences Unit Institute of Child Health Wolfson Centre London WC1N 2AP
  1. Correspondence to: Dr Ganesan

    Introduction

    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artery, is an important cause of stroke in this age group, accounting for 6% of cases in our series of 115 patients (unpublished data).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.

    Case report

    A 15 year old left handed boy fell off his skateboard, sustaining a blow to the right occiput without loss of consciousness. The next day he developed right occipital headache, blurred vision, nausea, and left hemiparesis, which extended to his face. The limb weakness and headache resolved over 24 hours but the facial weakness persisted. He had blurred vision and felt nauseated …

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