Neuroimaging in childhood arterial ischaemic stroke: evaluation of imaging modalities and aetiologies

Abstract

ACA Anterior cerebral artery AISAcute ischaemic stroke DWI Diffusion-weighted imaging MCA Middle cerebral artery MRA Magnetic resonance angiography AIM The aim of this study was to describe neuroimaging patterns associated with arterial ischaemic stroke (AIS) in childhood and to differentiate them according to stroke aetiology. RESULTS Stroke was confirmed in the acute period in 36 out of 41 children who underwent computed tomography, in 53 of 57 who underwent T2-weighted magnetic resonance imaging (MRI) and in all 48 children who underwent diffusion-weighted MRI. AIS occurred in the anterior cerebral artery (ACA) in 63 participants and in all cases was associated with lesions of the middle cerebral artery (MCA). The lesion was cortical-subcortical in 30 out of 63 children, cortical in 25 out of 63, and subcortical in 8 of 63 children. Among participants with AIS in the posterior circulation territory, the stroke was cortical-subcortical in 8 out of 16, cortical in 5 of 16, and thalamic in 3 out of 16 children.INTERPRETATION AIS mainly involves the anterior circulation territory, with both the ACA and the MCA being affected. The classification of Ganesan is an appropriate population-based classification for our Swiss cohort, but the neuroimaging pattern alone is insufficient to determine the aetiology of stroke in a paediatric population. The results show a poor correlation between lesion pattern and aetiology.

Hospitalização por acidente vascular encefálico isquêmico no Brasil: estudo ecológico sobre possível impacto do Hiperdia

“…Chen et al 35 observed that the mortality by stroke among young people has been kept stable in both lowand high-income countries. The stability here observed among individuals between 0 and 14 years of age may be explained by the difficulty of diagnosis of stroke among children 36 and, therefore, the absence of timely clinical decision making to reverse the case. In turn the instability in mortality of elderly aged 80 years old or older, it raises the possibility that these individuals have great vascular fragility and that small cerebrovascular events already produce significant deterioration of the nervous system, which makes the containment strategies little efficient for ongoing cerebrovascular events.…”

Factors affecting cognitive outcome in early pediatric stroke

“…Thus, 99 children : 1) early childhood group (1 mo-2 y 11 mo), 2) preschool group (3 y-5 y 11 mo), 3) middle childhood group (6 y-9 y 11 m), 4) late childhood group ($10 y). The assignment of lesion location was based upon a previous article 25 ) for children aged 6 years and older. Due to our prospective design, we had to include the use of the developmental test BSID-II to measure and determine the status of cognitive development before age 3.…”

Cortical reorganisation of cerebral networks after childhood stroke: impact on outcome

“…Exclusion criteria are ferrous implants, active epilepsy, claustrophobia and behavioural problems that make an MRI or TMS investigation impossible. According to previous data of the SNPSR [1,41,42] we expect an acute AIS sample of approximately 20 children within the study period of 3 years. Considering a potential drop-out rate of 20%, we aim to recruit 15 children with acute AIS for the longitudinal observational evaluation and 35 children with chronic AIS for the cross sectional evaluation.…”