[Arterial ischemic stroke in the healthy child. Practical approach (neonate and foetus excluded)]

Area of Science:

• Neurology
• Vascular Medicine
• Radiology

Background:

• Primary stroke arises from embolism or vascular wall obstruction.
• Sources of embolism include neck artery lesions, cardiac issues, and venous thrombosis with shunts.
• Cerebral arteriopathies encompass acute postviral carotid issues, Moya-Moya disease, and inflammatory conditions affecting small and medium arteries.

Purpose of the Study:

• To outline the etiological spectrum of primary stroke.
• To detail the diagnostic approaches for various cerebral arteriopathies.
• To discuss the indications for advanced imaging and systemic investigations.

Main Methods:

• Initial investigation relies on Magnetic Resonance Imaging (MRI) for anatomical assessment.
• Conventional cerebral angiography is considered for complex cases, such as evolving thrombosis requiring heparin, or potential endovascular interventions for aneurysms.
• Systemic investigations include cardiovascular assessment, thrombophilia screening, and dysimmune workup.

Main Results:

• Acute postviral arteriopathy of the supraclinoid carotid often stabilizes or regresses.
• Moya-Moya disease presents as an insidious obstructive arteriopathy with chronic insufficiency and recurrent strokes.
• Inflammatory arteriopathies, often secondary to systemic diseases, primarily affect smaller cerebral vessels.

Conclusions:

• Accurate etiological and anatomical diagnosis is crucial for managing primary stroke.
• MRI is the primary imaging modality, with angiography reserved for specific therapeutic or monitoring indications.
• A comprehensive diagnostic workup, including cardiovascular and thrombophilic assessments, is essential based on the clinico-anatomical findings.