Transient Cerebral Arteriopathy, Postvaricella Arteriopathy, and Focal Cerebral Arteriopathy or the Unique Susceptibility of the M1 Segment in Children With Stroke

Chabrier, Stéphane; Sébire, Guillaume; Fluss, Joël Victor

doi:10.1161/strokeaha.116.014606

Cited by 34 publications

(26 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Differential diagnoses related to childhood stenosing intracranial arteriopathies were excluded in our patients, based on evolution and thorough radiological analysis. The most frequent intracranial arteriopathy in children is focal – also called transient – cerebral arteriopathy, which is a focal, intracranial, and monophasic arterial disease . Rapid arterial normalization within 3 months may be seen in focal cerebral arteriopathy as in RCVS.…”

Section: Discussionmentioning

confidence: 99%

“…The most frequent intracranial arteriopathy in children is focalalso called transientcerebral arteriopathy, which is a focal, intracranial, and monophasic arterial disease. 10 Rapid arterial normalization within 3 months may be seen in focal cerebral arteriopathy as in RCVS. Conversely, bilateral, multifocal, proximal, and distal arterial stenoses are not described in focal cerebral arteriopathy.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Reversible cerebral vasoconstriction syndrome in paediatric patients with systemic lupus erythematosus: implications for management

Durrleman

Naggara

Grévent

et al. 2018

Develop Med Child Neuro

Self Cite

View full text Add to dashboard Cite

Microvascular brain injury is well recognized in neuropsychiatric systemic lupus erythematosus (SLE), but cerebral large artery involvement is being debated. Three females with SLE, aged 9 to 14 years, had immunosuppressive treatment intensification because of lupus nephritis. Within the following days or weeks, they presented with intense cephalalgia – isolated or associated with neurological symptoms – and no or mild hypertension. Magnetic resonance angiography showed multiple stenoses within the circle of Willis. One patient had subsequent small subcortical cerebral infarction. Two patients were treated for neuropsychiatric SLE; one patient was treated for reversible cerebral vasoconstriction syndrome (RCVS). Angiography normalized within a few weeks in all three patients. Retrospectively, clinical and radiological features suggest that RCVS was the most likely diagnosis in all patients. Multidisciplinary analysis of clinical and angiographic features is recommended, as RCVS is rare in children and its recognition may help to adjust treatment. What this paper adds Reversible vasoconstriction syndrome was observed in paediatric systemic lupus erythematosus. Thorough imaging analysis was necessary to address this diagnosis in paediatric patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Reversible cerebral vasoconstriction syndrome in paediatric patients with systemic lupus erythematosus: implications for management

Durrleman

Naggara

Grévent

et al. 2018

Develop Med Child Neuro

Self Cite

View full text Add to dashboard Cite

show abstract

“…This could be diagnosed, for instance, because of marked enhancement of the abnormal arterial segment on vessel wall imaging (VWI) 21 or preceding varicella zoster infection (if considered clinically relevant by the local pediatric stroke neurologist for a diagnosis of post-varicella arteriopathy). 22,23 FCA-i was also diagnosed when the evolution of the arteriopathy was typical of TCA: a stereotyped, monophasic natural history characterized by frequent early progression (over days to weeks), plateau with non-progression by six months, and subsequent improvement in some with complete resolution in a minority. 10,24 FCA that could not be further classified was considered “undetermined” (FCA-u) arteriopathy subtype (in which case the reviewers created a differential diagnosis).…”

Section: Methodsmentioning

confidence: 99%

Clinical and Imaging Characteristics of Arteriopathy Subtypes in Children with Arterial Ischemic Stroke: Results of the VIPS Study

Wintermark

Hills²,

deVeber

et al. 2017

AJNR Am J Neuroradiol

103

132

View full text Add to dashboard Cite

Introduction We quantified clinical and imaging characteristics associated with childhood arteriopathy subtypes to facilitate their diagnosis and classification in research and clinical settings. Methods The “Vascular effects of Infection in Pediatric Stroke” (VIPS) study prospectively enrolled 355 children with arterial ischemic stroke (AIS) (2010–2014). A central team of experts reviewed all data to diagnose childhood arteriopathy and classify subtypes, including arterial dissection, focal cerebral arteriopathy-inflammatory type (FCA-i, which includes transient cerebral arteriopathy, TCA), moyamoya, and diffuse/multifocal vasculitis. Only children whose stroke etiology could be conclusively diagnosed were included in these analyses. We constructed logistic regression models to identify characteristics associated with each arteriopathy subtype. Results Among 127 children with definite arteriopathy, the arteriopathy subtype could not be classified in 18 (14%). Moyamoya (n=34) occurred mostly in children <8 years old, FCA-i (n=25) in 8–15 year olds, and dissection (n=26) at all ages. Vertigo at stroke presentation was common in dissection. Dissection affected cervical arteries, while moyamoya involved supraclinoid internal carotid arteries. A banded appearance of the M1 segment of the middle cerebral artery was pathognomonic of FCA-i, but present in <25% of FCA-i cases; a small lenticulostriate distribution infarct was a more common predictor of FCA-i, present in 76%. It remained difficult to distinguish FCA-i from intracranial dissection of the anterior circulation (FCA-d). We observed only secondary forms of diffuse/multifocal vasculitis, mostly due to meningitis. Conclusions Childhood arteriopathy subtypes have some typical features that aid diagnosis. Better imaging methods, including vessel wall imaging, are needed for improved classification of FCA.

show abstract

“…If there is evidence of VZ infection in the 12 months preceding the onset of stroke symptoms, FCA-i is known as post-varicella angiopathy. 23,24 FCA-dissection type (FCA-d) refers to intracranial arterial dissection of the anterior circulation, typically in the setting of trauma. 25 Headache at the stroke ictus is common in FCA-i and FCA-d. 15 A diagnosis of FCA-i can also be considered when the evolution of the arteriopathy is typical, as originally reported for TCA: a dynamic self-limited time course characterized by early progressive arteriopathy during the first six months (peak in the initial 2-3 months) followed by stabilization or improvement.…”

Section: Unilateral Fcamentioning

confidence: 99%

“…FCA‐inflammation type (FCA‐i) refers to FCA that is presumed inflammatory, ie, thought to represent a focal acute large vessel vasculitis. If there is evidence of VZ infection in the 12 months preceding the onset of stroke symptoms, FCA‐i is known as post‐varicella angiopathy . FCA‐dissection type (FCA‐d) refers to intracranial arterial dissection of the anterior circulation, typically in the setting of trauma .…”

Section: Introductionmentioning

confidence: 99%

Neuroimaging of Pediatric Arteriopathies

Goyal

Malhotra

Almast

et al. 2019

Journal of Neuroimaging

View full text Add to dashboard Cite

Pediatric arteriopathies are increasingly recognized in school‐aged children with a variety of presenting symptoms ranging from headache, seizures, encephalopathy, and neuropsychiatric symptoms as well as focal neurologic deficits due to acute ischemic strokes. However, unlike the adult stroke population, there are differences in the clinical manifestations, the stroke mechanism, and risk factors in pediatric ischemic stroke. There has been increasing awareness and recognition of pediatric cerebral arteriopathies as a predominant stroke etiology. Prompt diagnosis of arteriopathies is essential to limit injury and prevent recurrent stroke. Based on predominant vessels involved and clinical symptoms, these arteriopathies can be broadly divided into two categories: large‐medium size arteriopathies and small vessel arteriopathies. Each category can be further divided into inflammatory and noninflammatory according to their etiologies. The ability to distinguish between inflammatory and noninflammatory etiologies carries major prognostic implications for acute management and secondary stroke prevention as well as screening for systemic complications and counseling.

show abstract

Transient Cerebral Arteriopathy, Postvaricella Arteriopathy, and Focal Cerebral Arteriopathy or the Unique Susceptibility of the M1 Segment in Children With Stroke

Cited by 34 publications

References 26 publications

Reversible cerebral vasoconstriction syndrome in paediatric patients with systemic lupus erythematosus: implications for management

Reversible cerebral vasoconstriction syndrome in paediatric patients with systemic lupus erythematosus: implications for management

Clinical and Imaging Characteristics of Arteriopathy Subtypes in Children with Arterial Ischemic Stroke: Results of the VIPS Study

Neuroimaging of Pediatric Arteriopathies

Contact Info

Product

Resources

About