Three cases of arterial ischemic stroke (AIS) following sports-related neck trauma are reported from Johns Hopkins University School of Medicine, Baltimore, MD. Case 1. A 10-year-old boy developed a left hemiparesis within a few minutes of colliding with another soccer player and sustaining a hit on his right head and neck. MRI revealed a right basal ganglia stroke. MRA showed no evidence of arterial dissection, and echocardiogram was normal. Treatment with heparin (UFH) followed by aspirin resulted in complete recovery. He was heterozygous for factor V mutation and MTHFR C677T polymorphism. Case 2. A 12-year-old boy sustained right neck and shoulder trauma during a lacrosse game. Later that night, he developed tingling of his right face and headache, and the next morning he awoke with vomiting, right-sided weakness, followed by nystagmus, truncal ataxia, and dysmetria of the right upper and lower limbs. MRI confirmed stroke in the right posterior pontomedullary junction. Traumatic vertebral artery dissection was suspected, and heparin was administered. Digital subtraction angiography (DSA) performed 12 h after admission showed no dissection, and heparin was replaced with aspirin. Echocardiogram revealed a small patent foramen ovale. Lipoprotein (a) level was elevated, and he was heterozygous for MTHFR C677T mutation. Recovery was almost complete after one month. Case 3. A 7-year-old boy had acute right-sided numbness and tingling 3 h after a karate chop to his neck. In the ER 1 hour later he had flaccid right-sided weakness of face, arm and leg. MRI showed infarcts in left parietal lobe, left medial medulla, and right cerebellum. DSA showed right vertebral artery dissection and occlusion. He recovered slowly and had no weakness at 1 year. 
COMMENT. Diagnosis of arterial ischemic stroke following minor athletic trauma is often delayed, with risk of progression or recurrence. Arterial dissection is associated in up to 20% cases. Treatment with anticoagulation is usually continued for 3 to 6 months . If dissection is not visualized by DSA, the Johns Hopkins authors recommend discontinuing anticoagulants and replacing with aspirin at time of discharge. Some restrictions on contact sports participation are generally followed. Recurrence risks of up to 30% are reported.
Endovascular therapy in pediatric intracranial carotid artery dissection is reported in a 12-year-old boy . Intra-arterial thrombolysis and stent reconstruction successfully recanalized the occluded arterial segment.