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Secondary parenchymal and vascular changes after middle cerebral artery stroke in children
Renzo Manara1, Stefano Sartori, Margherita Nosadini
1Neuroradiology, University of Salerno, via S. Allende, 84081, Baronissi, Italy, renzo.manara@sanita.padova.it.
Introduction:
Ischemic brain lesions might present with unexpected increased signal intensity at MR angiography within the ischemic lesion and secondary parenchymal changes in regions distal to the ischemia itself. We retrospectively investigated the rate and time course of vascular and parenchymal changes in children with isolated middle cerebral artery (MCA) stroke.
Methods:
Twelve children (mean age at stroke onset 4.8 years, range 0.8-15 years, six females, seven right MCA strokes) suffering from a first ever acute isolated MCA stroke had repeated MR scans (mean scan number, 3.5; range 2-6; mean follow-up, 11 months; range 0.5-24 months).
Results:
Ipsilaterally to MCA stroke, we recorded increased vessel signal at MR angiography during first to fourth day in 4/7 children (all had MCA recanalization), corticospinal tract cytotoxic-like edema during second day to second month in 7/11 (three children with globus pallidum ischemia had concomitant substantia nigra changes during second to third week), corticospinal tract T2 abnormalities from fifth day onwards in 9/12, focal thalamic cytotoxic-like edema during fifth day to first month in 5/8, focal thalamic T2 hyperintensity during sixth day to third week in 2/4, and faint T2 hypointensity from second month in 7/10 children.
Conclusion:
Vascular and secondary parenchymal changes, likely due to luxury perfusion, Wallerian, retrograde, or trans-synaptic degeneration, are common in pediatric MCA stroke population. They might mimic new ischemic lesions or suggest conditions different from stroke leading to diagnostic pitfalls and inappropriate treatment.
Insights
Secondary brain changes are common in pediatric middle cerebral artery (MCA) stroke. These vascular and parenchymal changes can mimic new lesions, potentially leading to misdiagnosis in children with MCA stroke.
Area of Science:
- Pediatric Neurology
- Neuroimaging
- Cerebrovascular Diseases
Background:
- Ischemic brain lesions can present with unexpected findings on MR angiography.
- Secondary parenchymal changes may occur in areas distal to the initial ischemic site.
- Understanding these changes is crucial for accurate diagnosis in pediatric stroke.
Purpose of the Study:
- To investigate the rate and time course of vascular and parenchymal changes in children with isolated middle cerebral artery (MCA) stroke.
- To characterize secondary changes following MCA stroke in pediatric patients.
- To identify potential diagnostic pitfalls associated with these findings.
Main Methods:
- Retrospective analysis of 12 children with first-ever acute isolated MCA stroke.
- Repeated MRI scans were performed with a mean follow-up of 11 months.
- Vascular and parenchymal changes were assessed using MR imaging.
Main Results:
- Increased vessel signal on MR angiography was observed in 4/7 children within the first to fourth day post-stroke, associated with MCA recanalization.
- Corticospinal tract edema and T2 abnormalities were common, appearing from the second day onwards.
- Thalamic edema and T2 hyperintensities were noted, with some cases showing globus pallidus and substantia nigra involvement.
Conclusions:
- Vascular and secondary parenchymal changes are frequent in pediatric MCA stroke.
- These changes, potentially due to luxury perfusion or degeneration, can mimic new ischemic events.
- Recognizing these secondary changes is vital to avoid diagnostic errors and ensure appropriate treatment in pediatric stroke patients.
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