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
ReviewSteno-occlusive Intracranial Large Vessel Arteriopathies in Childhood: A Pattern Oriented Approach to Neuroimaging Diagnosis.
Intracranial steno-occlusive large vessel arteriopathies refer to abnormalities of the arterial wall that typically express luminal stenosis. Notably, some entities that can find themselves within this category may also express luminal dilation, and/or aneurysm formation as an alternative phenotype. Intracranial steno-occlusive large vessel arteriopathies are a leading cause of arterial ischemic stroke (AIS) in children, often progress, and can predispose to recurrent brain infarction. Intracranial arterial dissections account for a subset of cases expressing the focal cerebral arteriopathy (FCA) phenotype because the affected arterial segment, clinical presentation, and AIS patterns are very similar to the inflammatory subtype of FCA.