Three cases of vomiting-associated cervical artery dissection

Extracranial Cervical Arterial Dissection (CAD) affects 10- 25% of young onset Acute Ischaemic Stroke (AIS) patients. We report three cases of CAD in young AIS patients (ages 14, 18 and 49) associated with prior vomiting. All three cases presented within five weeks of each other at a single centre, lived in a specific region in North-east Scotland suffering an outbreak of winter vomiting and were treated with IV thrombolysis. These cases are noteworthy for several reasons; reports of stroke in children treated with thrombolysis are rare, and new UK guidelines for stroke thrombolysis in children have been published; secondly we speculate that infective gastroenteritis triggered CAD, and thirdly the two younger cases developed vertebral artery pseudoaneurysms which are rare in CAD. In one case the presence of an anomalous vertebral artery course between the first and second cervical vertebrae may have predisposed to dissection.