Type:
Educational Exhibit
Keywords:
Ischaemia / Infarction, Haemorrhage, Arteriovenous malformations, Diagnostic procedure, MR, CT-Angiography, CT, Neuroradiology brain
Authors:
V. E. Montaño Claure1, E. M. Flores Armas2, U. Ruíz Martínez1; 1San Bartolo Coyotepec, Oaxaca/MX, 2Ciudad de Mexico/MX
DOI:
10.26044/ecr2019/C-1431
Findings and procedure details
Principal causes of stroke in children (29 days after birth to 18 years):
Ischemic stroke.-
AIS: Cardiac disorder, Moya Moya disease Fig.
1 ,
Cervicocephalic arterial dissection,
Focal cerebral arteriopathy, Anatomic variants of cerebral arteries Fig.
2 ,
Sickle cell anemia,
Central nervous system vasculitis,
Cerebral hipoxia Fig.
3 .
CSTV: infection,
trauma,
chronic conditions as anemia,
polycythemia and prothrombotic disorders Fig.
4 .
Hemorrhagic stroke: arteriovenous malformation (AVM’s) Fig.
5 ,
cavernous malformations and aneurysms Fig.
6 Fig.
7 .
Timely diagnosis of a stroke is a challenge,
neuroimaging plays an important role.
In our institution because of sometimes it is not easy to figure it out a diagnostic possibility,
due to the bad conditions in which patients arrive,
the image protocols are not always the indicated.
We reviewed the newest article,
and adopt the closest protocols as possible to the recommended.
In one of the lastest article,
there is a suggested imaging protocol for evaluating children with suspected stroke was devised by the International Paediatric Stroke Study (IPSS) Neuroimaging subgroup,
based in expert opinion and formal consensus Ref.
2; we used a little modified version Table 1 .
Ischemic Stroke:
AIS
- Non contrast head CT,
limited sensitivity.
- MRI “rapid brain” or hyperacute protocol: Diffusion- weighted imaging (DWI) and apparent diffusion- weighted coefficient (ADC) maps to confirm the diagnosis; susceptibility- weighted imaging (SWI) or gradient echo (GRE) sequences to assess for hemorrhage.
- Child who is medically unstable,
or contraindication to MRI or the center does not have MRI capabilities or because of the sedation we will delay any of them,
is going to do CT angiogram (CTA) of head and neck.
- If MR angiography (MRA) o CTA is nondiagnostic,
conventional catheter angiogram is necessary to elucidate the stroke etiology.
Moya Moya disease is one case in special that is need because of revascularization is considered.
CSTV
- CT: hiperdensity within the intracranial dural sinus (“dense clot sign”).
- Contrast- enhanced CT: triangular intraluminal filling defect (“empty delta sign”).
- MRI: The clot will have different findings in T1 and T2 weighted imaging,
depends the age of the clot.
- SWI: adept for visualizations of venous blood.
More sensitive than GRE or T1 spin echo (T1SE).
- Black- blood imaging: MRI technique suppressing the signal from normal flowing blood,
high sensitivity.
- Two- dimensional time of flight (TOF) MR venography.
- Three- dimensional phase- contrast magnetic resonance venography (MRV).
Hemorrhagic Stroke:
- CT: high sensitivity for detecting it.
- CTA or MRA.
- If no vascular malformation is detected and no hematologic cause or brain tumor is identified,
a conventional catheter angiogram should be considered.