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Updated: Feb 26, 2026
A Magnetic Resonance Imaging Protocol for Stroke Onset Time Estimation in Permanent Cerebral Ischemia
Published on: September 16, 2017
Transient Focal Neurologic Symptoms Correspond to Regional Cerebral Hypoperfusion by MRI: A Stroke Mimic in Children
L L Lehman1,2, A R Danehy1,3, C C Trenor1,4
1From the Stroke and Cerebrovascular Center (L.L.L., A.R.D., C.C.T., C.F.C., M.E.B.-L., M.J.R.).
Insights
Transient focal neurologic symptoms in children may mimic stroke. Advanced MRI techniques, including MRA and perfusion imaging, can differentiate these mimics from actual strokes by revealing reversible arterial changes and hypoperfusion without infarction.
Area of Science:
- Pediatric Neurology
- Neuroradiology
- Neuroimaging
Background:
- Acute transient focal neurologic symptoms in children often raise clinical suspicion for stroke.
- Distinguishing stroke mimics from actual ischemic events is critical for appropriate management.
Purpose of the Study:
- To evaluate the utility of advanced Magnetic Resonance (MR) imaging techniques in differentiating children with transient focal neurologic symptoms mimicking stroke from those with actual stroke.
- To identify specific imaging biomarkers indicative of stroke mimics.
Main Methods:
- Retrospective review of 16 children with transient focal neurologic symptoms.
- Utilized routine brain MR imaging, MR angiography (MRA), diffusion-weighted imaging (DWI), and perfusion-sensitive sequences (susceptibility-weighted imaging or arterial spin-labeling).
Main Results:
- No evidence of infarction on DWI in any patient.
- 88% of children showed unilateral arterial "pruning" on MRA without occlusion.
- All patients exhibited hemispheric hypoperfusion on perfusion imaging at presentation.
- Imaging findings normalized in those with follow-up after symptom resolution.
Conclusions:
- Advanced MR imaging, including MRA and perfusion techniques, can rapidly distinguish children with stroke mimics from those with acute stroke.
- Reversible arterial changes and hemispheric hypoperfusion without infarction are key imaging features of these stroke mimics.
Abstract:
Children who present with acute transient focal neurologic symptoms raise concern for stroke or transient ischemic attack. We present a series of 16 children who presented with transient focal neurologic symptoms that raised concern for acute stroke but who had no evidence of infarction and had unilateral, potentially reversible imaging features on vascular and perfusion-sensitive brain MR imaging. Patients were examined with routine brain MR imaging, MRA, perfusion-sensitive sequences, and DWI. Fourteen (88%) children had lateralized MRA evidence of arterial tree pruning without occlusion, all had negative DWI findings, and all showed evidence of hemispheric hypoperfusion by susceptibility-weighted imaging or arterial spin-labeling perfusion imaging at presentation. These findings normalized following resolution of symptoms in all children who had follow-up imaging (6/16, 38%). The use of MR imaging with perfusion-sensitive sequences, DWI, and MRA can help to rapidly distinguish children with conditions mimicking stroke from those with acute stroke.
