• Ko-Chiang Hsu, Hung-Wen Kao, and Shyi-Jou Chen.
• Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Neihu 114, Taipei, Taiwan, Republic of China.
• Am J Emerg Med. 2008 May 1; 26 (4): 519.e3519.e519005519.e3-5.

AbstractArterial dissection is a rare but serious cause of acute childhood stroke. Here, we present the case of a 15-year-old adolescent boy, an art school student, who suddenly experienced left hemi-paralysis after performing repeated backward somersaults, diagnosed as right-sided middle cerebral artery (MCA) hyperacute infarct due to isolated MCA dissection. Middle cerebral artery dissection in childhood is rare, as in our patient; however, pediatricians and emergency physicians should take MCA dissection into consideration in the differential diagnosis when hyperdense MCA sign is detected from unenhanced cranial computed tomography (CT) of childhood and/or adolescent stroke, with a special history such as backward somersault as in this case. Besides, unenhanced cranial CT and further imaging studies, including CT angiography and magnetic resonance imaging, provide a crucial role in early diagnosis to design proper treatment of acute childhood stroke in the ED.

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