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Paediatric Stroke: Review of the Literature and Possible Treatment Options, including Endovascular Approach.

Ciceri EF, Cuccarini V, Chiapparini L, Saletti V, Valvassori L - Stroke Res Treat (2011)

Bottom Line: Vascular abnormalities, such as arteriovenous malformations, aneurysms, vessel dissection, stenosis, and moyamoya disease, are frequently associated with both IS and HS and lead to high recurrence rates.Endovascular and surgical treatment options are sometimes indicated, performed on the basis of expert opinion, and extrapolated from the adult procedures.In the present paper, we review the recent literature and we discuss the treatment in five cases managed at our institutions.

View Article: PubMed Central - PubMed

Affiliation: Neuroradiology Department, Fondazione Istituto "C. Besta", Via Celoria 11, 20133 Milan, Italy.

ABSTRACT
Stroke is among the top 10 causes of death in childhood. More than half of the surviving children have long-term neurological sequelae. Ischemic stroke (IS) includes arterial ischemic stroke and cerebral venous thrombosis with venous infarction. Haemorrhagic stroke (HS) includes intracerebral haematoma or subarachnoid haemorrhage. Risk factors for stroke are different in children and in adults. 10-30% of IS have no identified risk factors. However, multiple risk factors are recognizable in the majority of stroke in children; thus, a comprehensive diagnostic evaluation is crucial. Vascular abnormalities, such as arteriovenous malformations, aneurysms, vessel dissection, stenosis, and moyamoya disease, are frequently associated with both IS and HS and lead to high recurrence rates. Endovascular and surgical treatment options are sometimes indicated, performed on the basis of expert opinion, and extrapolated from the adult procedures. In the present paper, we review the recent literature and we discuss the treatment in five cases managed at our institutions.

No MeSH data available.


Related in: MedlinePlus

MRA (a) and MRI sagittal sections (b), obtained 11 days after the initial symptoms, demonstrate the presence of a BA aneurysm with mass effect on the pons (arrowheads in (b)) and ischemic changes (not shown). At both edges of the aneurysm, stenosis of the BA is recognizable (arrows in (a)).
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fig1: MRA (a) and MRI sagittal sections (b), obtained 11 days after the initial symptoms, demonstrate the presence of a BA aneurysm with mass effect on the pons (arrowheads in (b)) and ischemic changes (not shown). At both edges of the aneurysm, stenosis of the BA is recognizable (arrows in (a)).

Mentions: The endovascular options in case of IS comprise (1) intra-arterial thrombolysis and/or mechanical revascularization in thromboembolic lesions, (2) revascularization procedures with stenting with or without angioplasty in stenoses or dissections, and (3) intra-arterial administration of vasodilator drugs in vessels spasm. In cases of HS due to bleeding from vascular malformations, endovascular repair with platinum detachable coils or flow diverter for aneurysms, and histoacrylic or polymeric glue injections in AVM are possible alternatives. In selected cases, surgical and endovascular approaches can be combined. An additional option for the treatment of small AVM is represented by radiosurgery [28]. In case of cardiac disease (i.e., PFO), correction of the cardiac defect should be considered.


Paediatric Stroke: Review of the Literature and Possible Treatment Options, including Endovascular Approach.

Ciceri EF, Cuccarini V, Chiapparini L, Saletti V, Valvassori L - Stroke Res Treat (2011)

MRA (a) and MRI sagittal sections (b), obtained 11 days after the initial symptoms, demonstrate the presence of a BA aneurysm with mass effect on the pons (arrowheads in (b)) and ischemic changes (not shown). At both edges of the aneurysm, stenosis of the BA is recognizable (arrows in (a)).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3140077&req=5

fig1: MRA (a) and MRI sagittal sections (b), obtained 11 days after the initial symptoms, demonstrate the presence of a BA aneurysm with mass effect on the pons (arrowheads in (b)) and ischemic changes (not shown). At both edges of the aneurysm, stenosis of the BA is recognizable (arrows in (a)).
Mentions: The endovascular options in case of IS comprise (1) intra-arterial thrombolysis and/or mechanical revascularization in thromboembolic lesions, (2) revascularization procedures with stenting with or without angioplasty in stenoses or dissections, and (3) intra-arterial administration of vasodilator drugs in vessels spasm. In cases of HS due to bleeding from vascular malformations, endovascular repair with platinum detachable coils or flow diverter for aneurysms, and histoacrylic or polymeric glue injections in AVM are possible alternatives. In selected cases, surgical and endovascular approaches can be combined. An additional option for the treatment of small AVM is represented by radiosurgery [28]. In case of cardiac disease (i.e., PFO), correction of the cardiac defect should be considered.

Bottom Line: Vascular abnormalities, such as arteriovenous malformations, aneurysms, vessel dissection, stenosis, and moyamoya disease, are frequently associated with both IS and HS and lead to high recurrence rates.Endovascular and surgical treatment options are sometimes indicated, performed on the basis of expert opinion, and extrapolated from the adult procedures.In the present paper, we review the recent literature and we discuss the treatment in five cases managed at our institutions.

View Article: PubMed Central - PubMed

Affiliation: Neuroradiology Department, Fondazione Istituto "C. Besta", Via Celoria 11, 20133 Milan, Italy.

ABSTRACT
Stroke is among the top 10 causes of death in childhood. More than half of the surviving children have long-term neurological sequelae. Ischemic stroke (IS) includes arterial ischemic stroke and cerebral venous thrombosis with venous infarction. Haemorrhagic stroke (HS) includes intracerebral haematoma or subarachnoid haemorrhage. Risk factors for stroke are different in children and in adults. 10-30% of IS have no identified risk factors. However, multiple risk factors are recognizable in the majority of stroke in children; thus, a comprehensive diagnostic evaluation is crucial. Vascular abnormalities, such as arteriovenous malformations, aneurysms, vessel dissection, stenosis, and moyamoya disease, are frequently associated with both IS and HS and lead to high recurrence rates. Endovascular and surgical treatment options are sometimes indicated, performed on the basis of expert opinion, and extrapolated from the adult procedures. In the present paper, we review the recent literature and we discuss the treatment in five cases managed at our institutions.

No MeSH data available.


Related in: MedlinePlus