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Updated: Jun 25, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Radiological strategy in acute stroke in children
Amalia Paonessa1, Nicola Limbucci, Elisabetta Tozzi
1Dept. of Neuroradiology, University Hospital S. Salvatore, L'Aquila, Italy. apaonessa7@hotmail.com
Insights
Pediatric stroke patterns show a higher prevalence of ischemic strokes (59%) over hemorrhagic strokes (41%). Magnetic resonance imaging (MRI) is recommended as the primary diagnostic tool for acute pediatric stroke management.
Area of Science:
- Neurology
- Pediatric Medicine
- Radiology
Background:
- Pediatric stroke is a critical neurological event requiring accurate diagnosis and management.
- Understanding the epidemiological patterns and etiological factors of pediatric stroke is essential for effective treatment strategies.
Purpose of the Study:
- To determine the prevalence of ischemic versus hemorrhagic pediatric stroke.
- To identify the various etiologies associated with pediatric stroke.
- To evaluate the diagnostic efficacy of imaging modalities in acute pediatric stroke management.
Main Methods:
- Retrospective analysis of 41 pediatric patients (age 5-16) with acute stroke over a 10-year period.
- Utilized magnetic resonance imaging (MRI), computed tomography (CT), and intra-arterial digital subtraction angiography (IADSA) for diagnostic assessment.
- Categorized strokes into ischemic and hemorrhagic types and investigated underlying causes.
Main Results:
- Ischemic strokes accounted for 59% (24 cases) and hemorrhagic strokes for 41% (17 cases).
- Identified diverse etiologies including arteriovenous malformation, cavernoma, aneurysm, sickle-cell disease, venous sinus thrombosis, and prothrombotic states.
- Etiology remained unknown in 20.5% of cases.
- MRI demonstrated superior diagnostic information compared to CT in acute pediatric stroke.
Conclusions:
- Ischemic strokes are more prevalent than hemorrhagic strokes in the pediatric population studied.
- A wide range of etiological factors contribute to pediatric stroke, necessitating comprehensive diagnostic workups.
- Magnetic resonance imaging (MRI) is the preferred initial imaging modality for acute pediatric stroke due to its comprehensive diagnostic capabilities.
Abstract:
The aim of the study was to estimate the preponderance of patterns of pediatric stroke, ischemic or hemorrhagic, their etiologies and the correct diagnostic protocol for acute management. Forty-one consecutive pediatric patients (age range 5-16 years) with an acute stroke observed in acute phase during a 10-year period, were retrospectively evaluated. Twenty-three patients underwent magnetic resonance imaging (MRI), 3 cases were studied by computed tomography (CT) without MRI, and 15 underwent both CT and MRI studies. In 9 cases, intra-arterial digital subtraction angiography (IADSA) was performed after non-invasive preliminary assessment. Seventeen hemorrhagic (41%) and 24 ischemic (59%) strokes were found. Among hemorrhagic forms, 5 cases were due to arteriovenous malformation (AVM), 7 to cavernoma, and 2 to aneurysm. Among ischemic forms, 2 were due to sickle-cell disease, 1 to hyperomocysteinemia, 1 to moyamoya syndrome, 1 to pseudoxantoma elasticum, 3 to prothrombotic state, 1 to Fabry's disease, 1 concomitant with CO intoxication, 5 to venous sinus thrombosis, and 4 to cardio-embolic state. Etiology remains unknown in 8 cases (20.5%). This study shows a moderate prevalence of ischemic over hemorrhagic strokes. Moreover, personal experience suggests that MRI is always more informative than CT and in selected cases should be the first-choice examination in the acute phase.
