Posterior cerebral artery dissection after excessive caffeine consumption in a teenager

Abstract

Arterial ischemic stroke is a rare but significant cause of neurological deficits in childhood. Even though there is a variety of risk factors, identifying the etiology can sometimes be a hard diagnostic challenge. Arteriopathies in general, and more specifically, arterial dissection is one of the uncommon pathologies that can cause incidents of pediatric stroke. We report a rare case of a young adolescent with posterior cerebral artery dissection after excessive consumption of caffeine, contained in energy drinks, only hours before the onset of neurological symptoms. A complete neuroimaging evaluation (MRI, intracranial US and digital subtraction angiography) at the admission and during the follow-ups supported the diagnosis of arterial dissection possibly caused by caffeine overconsumption.

Keywords: Caffeine; Dissection; Pediatric stroke; Posterior cerebral artery.

Fig. 1

MRI on Day 1. (A) There exists a high signal in the cortex of the inner surface of the left occipital lobe and in the left thalamus (arrow). (B) The lesions have a low signal on the ADC map characteristic for ischemia. C) On a 3D-TOF oblique projection, there is a narrowing at the P1-P2 junction while the P4 segment is not apparent.

Fig. 2

Imaging on Day 4 shows the typical “string and pearl” sign of the left P2 and P3 PCA segments on 3D-TOF sequences.

Fig. 3

Intracranial Doppler ultrasonographic examination at the level of the left P1-P2 segment shows an attenuated flow pattern compared to the contralateral side (not shown).

Fig. 4

Digital subtraction angiography on Day 11 demonstrates the typical “string and pearl” sign at the level of the left P1-P2 junction and distally.

Fig. 5

Imaging on day 30 shows residual narrowing of the left PCA.