Neuroimaging clinics of North America
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Neuroimaging Clin. N. Am. · Nov 2024
ReviewIntroduction: Neurovascular Diseases across the Pediatric Age Spectrum.
Pediatric cerebrovascular diseases have distinct clinical presentations, pathophysiology, and management compared to the adult counterparts. This introductory article discusses the imaging techniques and neurovascular conditions unique to each age group from the fetal stages through childhood, including vascular malformations, arteriopathy, and strokes. The article also underscores the importance of genetic factors and the need for a multidisciplinary approach in the diagnosis and treatment of pediatric neurovascular disorders.
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Hemorrhagic stroke (HS) is an important cause of neurologic morbidity and mortality in children and is more common than ischemic stroke between the ages of 1 and 14 years, a notable contradistinction relative to adult stroke epidemiology. Rapid neuroimaging is of the utmost importance in making the diagnosis of HS, identifying a likely etiology, and directing acute care. Computed tomography and MR imaging with flow-sensitive MR imaging and other noninvasive vascular imaging studies play a primary role in the initial diagnostic evaluation. Catheter-directed digital subtraction angiography is critical for definitive diagnosis and treatment planning.
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Intracranial vascular malformations (IVMs) represent a significant challenge in pediatric medicine due to their diagnostic and therapeutic complexity. Despite their rarity, the severity of potential neurologic outcomes necessitates a comprehensive understanding and approach to management. ⋯ Vein of Galen malformations, pial arteriovenous fistulas, dural sinus malformations, and intracranial venous malformations will be addressed in other articles. Following a discussion of imaging and clinical considerations within the field, novel imaging techniques will be discussed.
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Arterial ischemic stroke (AIS) in children has a high mortality and life-long disability rate in surviving patients. Diagnostic delays are longer and risk factors are different compared with AIS in the adult population. ⋯ New revascularization time windows in children require the definition of diagnostic protocols for stroke in each referral center. In this article, we discuss the neuroimaging techniques and protocols, describe the main underlying causes, and review the current treatment options for pediatric and perinatal AIS.
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Neuroimaging Clin. N. Am. · Nov 2024
ReviewSpecial Considerations for Cross-Sectional Imaging in the Child with Neurovascular Disease.
Pediatric neurovascular diseases are a complex group of disorders associated with significant morbidity and mortality. Given their heterogeneous clinical manifestations, ranging from emergent presentations (eg, acute neurologic deficits) to chronic neurocognitive or developmental issues, cross-sectional imaging modalities play a key role in accurate diagnosis and direct further management. However, imaging pediatric patients is associated with logistical and technical issues. This article provides an overview of the cross-sectional findings of common pediatric neurovascular diseases and discusses the imaging techniques used for their diagnosis.