Introduction Mechanical thrombectomy is standard treatment for large vessel occlusion (LVO) in adults. There are no randomized controlled trials for the pediatric population. We report our single-center experience with thrombectomy of LVO in a series of pediatric patients, and perform a review of the literature. Methods Retrospective review of consecutive pediatric thrombectomy cases between 2011 and 2018. Demographic variables, imaging data, technical aspects and clinical outcome were recorded. Results In a period of 7 years, 7 children were treated for LVO at our center. Median age was 13 (2–17), and median Ped-NIHSS was 15 (3–24), and the median ASPECTS was 8 (2–10). Five patients had cardiac disease, and 2 of them were under external cardiac assistance. Median time from onset of symptoms to beginning of treatment was 7h06m (2h58m–21h38m). Five patients had middle cerebral artery occlusions. Thrombectomy was performed using a stentriever in 3 patients, aspiration in 3 patients, and combined technique in 1 patient. Six patients had good recanalization (TICI 2 b/3). There were no immediate periprocedural complications. At 3 months, 4 patients (57%) were independent (mRS score <3). Two patients died, one after haemorrhagic transformation of an extensive MCA infarct, and one due to extensive brainstem ischemia in the setting of varicella vasculitis. Discussion Selected pediatric patients with LVO may be treated with mechanical thrombectomy safely. In patients under external cardiac assistance and under anticoagulation, thrombectomy is the only alternative for treatment of LVO. A multidisciplinary approach in specialized pediatric stroke centers with trained neurointerventionalists are essential for good results.

Purpose To evaluate the potential role of Magnetic Resonance Imaging (MRI) in the diagnosis of uveal melanoma. Methods Retrospective case series involving a total of 10 patients, 9 with uveal melanoma and 1 with a suspicious melanocytic lesion, diagnosed by A‐mode and B‐mode ultrasound (US) scan. 6 of the 10 patients simultaneously performed MRI for diagnostic purposes. The results of both modalities were compared with respect to lesion dimensions, extra‐scleral extension and presence of retinal detachment (RD). Results In this case series, 4 patients were diagnosed with uveal melanoma based exclusively on echographic findings and 6 patients underwent both US and MRI for diagnostic purposes. The MRI excluded the diagnosis of uveal melanoma in one patient with suspected US imaging. In the remaining 5 patients that underwent both modalities, we did not identify significant differences in lesion dimensions. Extra‐scleral extension was not identified in this subgroup by US, and MRI findings corroborated these results. With respect to RD, it was identified in 2 of these 6 subjects by US but MRI failed to identify a discrete RD in one of the subjects. Conclusions The present case series focused on the differences between US and MRI in the diagnosis of uveal melanoma in order to assess the potential role of MRI in such cases. We did not find any difference in diagnostic accuracy, lesion dimensions and detection of extra‐scleral extension between the two modalities, except for one patient with a suspected lesion on US that was excluded with MRI. US, however, was found to be more sensitive than MRI in the diagnosis of RD, detecting a small RD not identified by MRI. The authors identify as main limitation the small number of subjects included in the case study. Further studies involving a greater number of patients are necessary to precisely determine the role of MRI in diagnosis of uveal melanoma.

Pediatric ischemic stroke is an underOrecognized condition, frequently leading to delayed diagnosis. Most childhood strokes are due to intracranial arteriopathy, wherein mechanical thrombectomy is not applicable. Conversely, cardioembolic strokes may benefit from mechanical intervention, similarly to adults. Despite strong evidence for endovascular therapy in adults with acute ischemic stroke, limited data exist in children and adolescents.Methods: We performed a retrospective review of all cases of endovascular treatment of acute ischemic stroke in the pediatric population at our center between 2011 and 2018. Discussion/Conclusion: With the rise of mechanical trombectomy for the treatment of LVO stroke, increasing numbers of treated strokes in the pediatric population are expected. Mechanical thrombectomy seems safe and feasible in the pediatric population. Multidisciplinary selection of pediatric patients with LVO is warranted. Larger prospective studies are needed to validate these conclusions.

Background Idiopathic intracranial hypertension (IIH) has well-described imaging findings, typically reversible with the adequate treatment. We hereby report a case of IIH with a peculiar imaging finding, that to our knowledge and by the research conducted, has never been described before—cerebro-spinal fluid (CSF) transudation across the optic nerve sheath. Case presentation A 15-year-old girl with a 2-week history of occipital headache, nausea and vomiting, diplopia, blurred vision and tinnitus in her right ear, was admitted in the neuropediatric department and after extensive diagnostic work-up was diagnosed with IIH. The MRI showed typical signs of idiopathic intracranial hypertension, including enlargement of the perioptic CSF spaces associated with a peculiar finding described as a blurred hyperintensity T2/FLAIR of the perioptic fat, which was likely related to transudation of CSF. The adequate medical therapy (including corticosteroids and acetazolamide) for 2 weeks didn’t revert the signs and symptoms and so a lumboperitoneal shunt was placed with complete resolution of the clinical picture and the imaging findings described. Conclusions The documentation of CSF transudation around the optic nerve in the setting of hydrops has never been reported before and should be recognized by the neuroradiologist. It seems to be reversible, like the other findings of IIH and its physiopathology is not clear.

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