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Radiology of ischemic strokes in children
Insights
Pediatric arterial ischemic strokes, often linked to heart conditions, distress, or vasculitis, are diagnosed using CT scans. Ultrasound is a promising tool for neonates, revealing specific features like vasculitis.
Area of Science:
- Pediatric Neuroradiology
- Cerebrovascular Diseases
- Pediatric Neurology
Background:
- Arterial ischemic strokes are common in pediatric neuroradiology.
- Etiologies include congenital heart disease, neonatal distress, infections causing vasculitis, and idiopathic cases.
- Diagnosis relies on CT, with ultrasound showing promise in neonates.
Purpose of the Study:
- To review the diagnostic features and etiologies of arterial ischemic strokes in children.
- To highlight age-specific presentations and imaging findings.
- To discuss the role of angiography in evaluating arterial lesions.
Main Methods:
- Review of CT and ultrasound imaging in pediatric stroke cases.
- Analysis of etiological factors, including congenital heart disease, neonatal distress, and vasculitis.
- Correlation of imaging findings with etiological data from angiography.
Main Results:
- CT features are similar to adults, but infarct location can be specific to children (e.g., basal ganglia).
- Infarcts are often multiple and hemorrhagic, affecting gray matter primarily, and white matter in young infants.
- Angiography reveals arterial bed impairment, collateral supply, and specific vasculitis patterns (e.g., string-of-beads).
Conclusions:
- Pediatric arterial ischemic strokes have distinct etiologies and imaging features.
- Vasculitis is a key finding in pediatric stroke, presenting with various morphological changes.
- Multimodality imaging is crucial for diagnosis, etiological assessment, and understanding sequelae.
Abstract:
Arterial ischemic strokes are a relatively frequent diagnostic occurrence in pediatric neuroradiology. They occur mostly in three main etiologic contexts: congenital heart disease; neonatal distress; infections, focal or general inducing vasculitis, but many cases are considered idiopathic. The positive diagnosis is made by CT; in neonates, however, ultrasound appears as a promising tool. The CT features are basically similar at that age and in adults, although the site of the infarct may result from pathologies more particular to children (e.g. basal ganglia infarction due to arteritis of the carotid siphon and its branches). Infarcts may be multiple and also more frequently hemorrhagic at that age, the hemorrhagic phenomena affecting only the gray matter except in young infants in which the subcortical white matter may be affected also. Anatomical sequels include focal atrophy and asymmetry of the brain. Data regarding the etiology can be gathered from angiography which may show the degree of impairment of the arterial bed, its extent, the collateral blood supply and the morphological type of arterial lesion responsible for the cerebral damage. The most particular picture at that age is that of the often diffuse vasculitis, with its various expressions (segmental narrowing of the lumen, dissecting aneurysm, string-of beads appearance).