Radiology of ischemic strokes in children

Abstract

Arterial ischemic strokes are a relatively frequent diagnostic occurrence in pediatric neuroradiology. They occur mostly in three main etiologic contexts: congenital heart disease; neonatal distress; infections, focal or general inducing vasculitis, but many cases are considered idiopathic. The positive diagnosis is made by CT; in neonates, however, ultrasound appears as a promising tool. The CT features are basically similar at that age and in adults, although the site of the infarct may result from pathologies more particular to children (e.g. basal ganglia infarction due to arteritis of the carotid siphon and its branches). Infarcts may be multiple and also more frequently hemorrhagic at that age, the hemorrhagic phenomena affecting only the gray matter except in young infants in which the subcortical white matter may be affected also. Anatomical sequels include focal atrophy and asymmetry of the brain. Data regarding the etiology can be gathered from angiography which may show the degree of impairment of the arterial bed, its extent, the collateral blood supply and the morphological type of arterial lesion responsible for the cerebral damage. The most particular picture at that age is that of the often diffuse vasculitis, with its various expressions (segmental narrowing of the lumen, dissecting aneurysm, string-of beads appearance).

Clinical survey of ischemic cerebrovascular disease in children in a district of Japan.

“…Follow-up angiography showed relatively good recovery from such lesions. As Raybaud et al 6 have indicated, the cerebral ischemia in such cases may have been caused by vasculitis or vasospasm. Infections preceding cerebral infarction need not be confined to the head and neck region and are generally systemic disorders, so the possibility of vasculitis cannot be excluded.…”

“…Although the number of reported cases is small, a number of articles have clarified the clinical features of juvenile cerebral infarction. 2 -8 From previous reports and the previously common diagnosis of acute infantile hemiplegia, the onset of cerebral infarction in children is often accompanied by motor paresis, 6 is most frequent in little children and junior high school-age children, and is equally common in girls and boys. 48 Our survey confirms these features.…”

Multimodality Evoked Potentials in Children with Moyamoya Disease

“…The clinical features relate to progressive cerebral occlusive lesions. Children are more vulnerable than adults, probably because of the high requirement of cerebral blood flow and metabolism (12). We found a significant correlation between neurologie deficits and abnormalities in evoked potentials.…”

Internal Carotid Artery Occlusion Following Correction of Atypical Aortic Coarctation-Case Report-

“…8,11,12,18) Occlusion of the intracranial vessels is less commonly caused by hematologic disorders or coagulopathies, and collagen vascular diseases (such as fibromuscular dysplasia, neurofibromatosis, etc.). 7,9,14,16) Arteriosclerosis is an uncommon etiology of cerebral ischemia in children, although a major cause of cerebrovascular disease in adults.…”