Cerebrovascular disorders in childhood: etiology, clinical presentation, and neuroimaging findings in a case series study

Abstract

OBJECTIVE: To describe the main etiologies, neurological manifestations and neuro-imaging findings among children with sequelae of cerebrovascular disorders. METHOD: Case series study of children whose diagnosis was stroke sequelae. Variables studied were age at the time of first episode, number of episodes, etiology, motor deficits, epilepsy, and effected vascular territory. RESULTS: Twenty three patients were studied. Average age at first episode was 6.91 (±2.08) years. Fourteen patients were female. The number of stroke events per patient ranged from one to five. The most frequent etiologies were heart disease and sickle cell anemia. The most frequent neurological deficit was right hemiparesis. Nine patients experienced seizures. The left middle cerebral artery was the most affected vascular area. CONCLUSION: Our findings are similar to those described in the literature. Despite a careful investigation, some causes of stroke remain unidentified.

Neuroimaging in childhood arterial ischaemic stroke: evaluation of imaging modalities and aetiologies

“…Neuroimaging is of great importance in the diagnosis of childhood AIS, and has a major influence on its acute and long‐term management. Our finding that the most commonly involved artery is the MCA (55/79, 70%) confirms reports in the literature 12,13 . In addition, and confirming the findings of Miravet et al., 4 involvement of the ACA was never seen in isolation and occurred only in combination with an MCA lesion.…”

Atención al accidente cerebro vascular infantil: perspectiva de la neurología pediátrica

“…Las principales causas se producen debido a la participación isquémica o trombótica de la arteria cerebral media izquierda, lo que refleja un déficit motor caracterizado por hemiparesia derecha, trastornos visuales, del comportamiento y aprendizaje, y la epilepsia. 6,13 Tanto la literatura como los neuropediatras participantes en el estudio, evidencian las cardiopatías, vasculopatías y las enfermedades hematológicas, especialmente la enfermedad de células falciformes como las principales causas de ACV en la infancia. Sin embargo, las enfermedades infecciosas como el SIDA, la varicela y la meningitis son enfermedades que no se pueden descartar como un factor de riesgo para el ACV infantil, ya que muchos casos se producen durante el proceso infeccioso.…”

“…A pesar de una cuidadosa investigación, algunas de las causas permanecen sin identificar. 13 Es de notar la dificultad en el diagnóstico de la enfermedad cerebro vascular en la infancia, especialmente en recién nacidos y lactantes en los que, con frecuencia, la semiología es poco expresiva. Según lo citado en la entrevista y en la literatura, existe la posibilidad de que algunos niños hayan sido atendidos varias horas después de la instalación de la agresión, puesto que los signos y síntomas iniciales no fueron recuperados hasta el momento de los síntomas epilépticos y trastornos motores.…”

Stroke in children

“…A angiografia digital cerebral deveria ser sempre considerada quando achados negativos ou conflitantes são encontrados na RM ou quando nenhuma evidência radiológica ou laboratorial for encontrada para a causa do AVE. O exame também é indicado em crianças com a doença de Moyamoya que serão submetidas a cirurgia de vascularização 74 . Como descrito por Matta et al 75 , em uma série de casos retrospectiva, quase 83% das crianças com AVC isquêmico agudo tinham obstrução da artéria cerebral média, confirmada por outros estudos como a artéria mais comumente envolvida em AVE infantil.…”