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Updated: Nov 2, 2025
A Thrombotic Stroke Model Based On Transient Cerebral Hypoxia-ischemia
Published on: August 18, 2015
Arteriopathy in pediatric stroke: an underestimated clinical entity
Ronaldo Pizzatto1, Lucas Lopes Resende1, Carlos Felipe Teixeira Lobo1
1Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto de Radiologia, São Paulo SP, Brazil.
Insights
Pediatric arterial ischemic stroke (AIS) is increasingly recognized. This review details causes, imaging, and proposes a modified classification for better diagnosis and outcomes in children.
Area of Science:
- Neurology
- Pediatrics
- Radiology
Background:
- Pediatric arterial ischemic stroke (AIS) is increasingly recognized as a significant cause of neurological morbidity in children.
- Advances in neuroimaging have improved the detection and diagnosis of AIS.
Purpose of the Study:
- To review the primary etiologies of stroke resulting from arteriopathy in pediatric patients.
- To propose a modified classification for childhood AIS based on anatomical site and specific causes.
Main Methods:
- Analysis of a case series from the institution.
- Review of epidemiological aspects, pathophysiology, and imaging findings (CT, MR angiography, conventional MR, MR DWI).
- Inclusion of nuclear medicine findings and discussion of the Childhood AIS Standardized Classification and Diagnostic Evaluation (CASCADE).
Main Results:
- Identified key etiologies including vasculitis, varicella, arterial dissection, moyamoya disease, fibromuscular dysplasia, Takayasu's arteritis, and genetic causes (e.g., ACTA-2 mutation, PHACE syndrome, ADA-2 deficiency).
- Detailed the specific characteristics of each identified etiology.
- Proposed a modified classification system for childhood AIS.
Conclusions:
- Prompt recognition and thorough investigation of risk factors are essential for improved outcomes in pediatric AIS.
- Neurovascular imaging is crucial for diagnosing AIS and identifying children at high risk of recurrent stroke.
Background:
Pediatric arterial ischemic stroke (AIS), which was thought to be a rare disorder, is being increasingly recognized as an important cause of neurological morbidity, thanks to new advances in neuroimaging.
Objective:
The aim of this study was to review the main etiologies of stroke due to arteriopathy in children.
Methods:
Using a series of cases from our institution, we addressed its epidemiological aspects, physiopathology, imaging findings from CT, MR angiography, MR conventional sequences and MR DWI, and nuclear medicine findings.
Results:
Through discussion of the most recent classification for childhood AIS (Childhood AIS Standardized Classification and Diagnostic Evaluation, CASCADE), we propose a modified classification based on the anatomical site of disease, which includes vasculitis, varicella, arterial dissection, moyamoya, fibromuscular dysplasia, Takayasu's arteritis and genetic causes (such as ACTA-2 mutation, PHACE syndrome and ADA-2 deficiency). We have detailed each of these separately. Conclusions: Prompt recognition of AIS and thorough investigation for potential risk factors are crucial for a better outcome. In this scenario, neurovascular imaging plays an important role in diagnosing AIS and identifying children at high risk of recurrent stroke.
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