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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

The axial T2 MR study performed 3 days after symptoms onset demonstrates the ischemic lesions in the pons and right occipital cortex.
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fig10: The axial T2 MR study performed 3 days after symptoms onset demonstrates the ischemic lesions in the pons and right occipital cortex.

Mentions: A 3-year-old African boy presented with sudden onset of nausea and vomiting. He was admitted to the Emergency Room hypotonic, hyporeactive, with abnormal ocular movements and recurrent seizures. In the recent past medical history, only sporadic headache was reported, after a varicella infection. At brain CT a hyperdense basilar artery was visible (arrow in Figure 9). At MRI with MRA, ischemic lesions in the vertebrobasilar territory with severe obstruction of the basilar and right posterior cerebral arteries were observed. As some hours had already passed from symptoms onset and the experience as well as the literature data on thrombolysis in children were poor, it was decided not to proceed to thrombolysis neither by venous nor arterial route. In addition, clinical conditions, though severe, did not seem to be life-threatening at that moment. Over the next few days, patient clinical conditions slowly but progressively improved. An MRI control at day 3 showed a new lesion in the pons (Figure 10). A DSA performed at day 12 confirmed the MRI findings: occlusion of the basilar artery from the vertebrobasilar (VB) junction to the tip, with good collaterals supplying the brainstem perforators and partial revascularization of the superior cerebellar arteries (arrows in Figure 11).


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)

The axial T2 MR study performed 3 days after symptoms onset demonstrates the ischemic lesions in the pons and right occipital cortex.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig10: The axial T2 MR study performed 3 days after symptoms onset demonstrates the ischemic lesions in the pons and right occipital cortex.
Mentions: A 3-year-old African boy presented with sudden onset of nausea and vomiting. He was admitted to the Emergency Room hypotonic, hyporeactive, with abnormal ocular movements and recurrent seizures. In the recent past medical history, only sporadic headache was reported, after a varicella infection. At brain CT a hyperdense basilar artery was visible (arrow in Figure 9). At MRI with MRA, ischemic lesions in the vertebrobasilar territory with severe obstruction of the basilar and right posterior cerebral arteries were observed. As some hours had already passed from symptoms onset and the experience as well as the literature data on thrombolysis in children were poor, it was decided not to proceed to thrombolysis neither by venous nor arterial route. In addition, clinical conditions, though severe, did not seem to be life-threatening at that moment. Over the next few days, patient clinical conditions slowly but progressively improved. An MRI control at day 3 showed a new lesion in the pons (Figure 10). A DSA performed at day 12 confirmed the MRI findings: occlusion of the basilar artery from the vertebrobasilar (VB) junction to the tip, with good collaterals supplying the brainstem perforators and partial revascularization of the superior cerebellar arteries (arrows in Figure 11).

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