Neurovascular disorders in children: an updated practical guide

Abstract

Stroke is defined by the WHO as a rapid deterioration in neurological symptoms lasting more than 24 hours with a vascular origin (1). It is an important cause of longterm morbidity and mortality in children. The incidence of childhood stroke varies amongst different population studies and lies between 2-13 per 100,000 (2-4).Paediatric stroke is classified as either perinatal (≤28 days of age) or childhood (>28 days of age) (5). The focus of this article will be on childhood stroke.Childhood stroke can be further subdivided into ischaemic and haemorrhagic stroke (Figure 1). Ischaemic stroke encompasses both arterial ischaemic stroke (AIS) and venous infarction secondary to cerebral venous sinus thrombosis (CVST) or cortical vein thrombosis (6). CVST is frequently accompanied by areas of parenchymal haemorrhage. AIS Epidemiology and risk factorsPaediatric stroke is classified as either perinatal/neonatal (28 days of age) or childhood (>28 days of age). The definition of AIS is shown in Table 1.The major risk factors that cause adult strokes such as atherosclerosis and associated conditions such as hypertension and dyslipidaemia are irrelevant in childhood. The aetiology of AIS in childhood differs from adults, is complex and more often multifactorial. The age of the child is also an important factor with stroke in the neonatal stage having a unique set of considerations to strokes in an older Review Article on Pediatric Neuroradiology for Trainees and Fellows: An Updated Practical Guide

Analysis of 6 pediatric nephrotic syndrome cases with complications of cerebral sinovenous thrombosis and literature review

“…However, there are still many misdiagnoses and missed diagnoses in clinical practice, even with the availability of more sophisticated imaging techniques. This is because the venous sinus is close to the dura mater, and it can sometimes be mistaken for subarachnoid hemorrhage or arachnoid granulation on imaging ( 21 , 22 ). Plain CT is the first-line imaging modality for headache, but it has a high missed diagnosis rate of up to 30%–40% for CVST in children ( 23 ).…”

“…It can show discontinuous, heterogeneous low blood flow signals or even no blood flow signals, depending on the degree of stenosis of the embolic venous sinus. This helps to compensate for the false-negative rate of MRI ( 21 ). In addition to focusing on the direct signs of a clot, assessing any damage to the cerebral parenchyma secondary to the thrombosis by looking for signs of hemorrhage or infarction can also be helpful for the diagnosis of CVST.…”

Pediatric Interventional Neuroradiology: Opportunities and Challenges

“…The most common risk factors for the occurrence of stroke in children are vasculopathy, infections, congenital and acquired cardiac disease, and coagulopathies [ 34 ]. As in adults, CT imaging is the modality of choice for acute presentations of focal neurologic deficits in children, with CT angiography being performed in a suspected large vessel occlusion [ 35 , 36 ].…”

Pediatric ischemic stroke : Epidemiological aspects of validity, risk factors, and outcomes

“…In the younger ages, congenital heart disease, genetic, or metabolic disorders are influential risk factors. 45 In late adolescence, the risk factors of adult ischemic stroke (e.g., dyslipidemia and hypertension) increases in frequency 46 albeit still uncommon. Rather, chronic head and neck associated disorders (Table 2) are more frequent at this age.…”

“…43 Furthermore, there is an unexplained overrepresentation of boys with ischemic stroke. 31 The single most common cause of childhood ischemic stroke seems to be arteriopathy, 43,45 which is also one of few identified predictors of recurrence. 47 However, arteriopathy is not only one disease but includes a range of diagnoses, for example Moya Moya disease and several forms of vasculitis.…”