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[Specifics in pediatric arterial cerebral infarctions]
S Chabrier1, P Lasjaunias, M Tardieu
1Service de pédiatrie et génétique, hôpital Nord, 42055 Saint-Etienne, France.
Insights
Pediatric ischemic cerebrovascular disease is categorized into major types like cardioembolic stroke and moyamoya syndrome. Accurate diagnosis through investigations guides treatment and recurrence risk prediction for better outcomes.
Area of Science:
- Neurology
- Pediatrics
- Vascular Medicine
Context:
- Pediatric ischemic cerebrovascular disease presents diverse etiological origins.
- Accurate classification is crucial for effective management and prognosis.
Purpose:
- To outline the primary etiological categories of pediatric ischemic cerebrovascular disease.
- To detail diagnostic investigations for identifying stroke causes in children.
- To emphasize the link between diagnosis, treatment, and recurrence risk.
Summary:
- Children's ischemic strokes are typically classified into cardioembolic events, moyamoya syndrome, systemic disease complications, cervicocephalic arterial dissection, or transient cerebral arteriopathy.
- Diagnostic workup involves cardiac evaluations, neuroimaging (MRI, angiography), cervical artery assessment (echo-doppler), and cerebrospinal fluid analysis.
- Environmental factors like trauma and infections, alongside genetic predisposition, contribute to cerebrovascular events.
Impact:
- Facilitates precise diagnosis for tailored therapeutic strategies in pediatric stroke.
- Improves prediction of stroke recurrence, enabling preventative measures.
- Enhances understanding of multifactorial causes, including genetic and environmental influences, in pediatric cerebrovascular disease.
Abstract:
Despite the number of potential causes, most children with ischemic cerebrovascular disease are classified into a few major categories: 1) cardioembolic stroke; 2) moyamoya syndrome; 3) complication(s) connected with systemic disease, with a known risk of a cerebrovascular event; 4) cervicocephalic arterial dissection; and 5) transient cerebral arteriopathy of undefined origin (probable arteritis). The etiological diagnosis is rapidly established by complementary investigations based on the initial clinical and imaging findings: cardiac exploration, magnetic resonance imaging and angiography or echo-doppler of the cervical arteries if cervical dissection is suspected; intra-arterial catheter cerebral angiography and analysis of the cerebrospinal fluid to investigate an intracranial arteriopathy. The outcome and treatment depend on the type of stroke, on its accurate identification, and on prediction regarding the risk of recurrence. Although there is a constitutional predisposition to cerebrovascular accidents, environmental triggers such as trauma, infectious disease and cardiac surgery also play a major role.