Neuroimaging of Pediatric Intracerebral Hemorrhage

Abstract

Hemorrhagic strokes account for half of all strokes seen in children, and the etiologies of these hemorrhagic strokes differ greatly from those seen in adult patients. This review gives an overview about incidence and etiologies as well as presentation of children with intracerebral hemorrhage and with differential diagnoses in the emergency department. Most importantly it describes how neuroimaging of children with intracerebral hemorrhage should be tailored to specific situations and clinical contexts and recommends specific imaging protocols for acute and repeat imaging. In this context it is important to keep in mind the high prevalence of underlying vascular lesions and adapt the imaging protocol accordingly, meaning that vascular imaging plays a key role regardless of modality. Magnetic resonance imaging (MRI), including advanced sequences, should be favored whenever possible at the acute phase.

Arterial Spin Labeling for the Etiological Workup of Intracerebral Hemorrhage in Children

“…1,2 While large AVS are not difficult to diagnose with routine anatomic imaging outside the acute phase, the hemorrhage mass effect can obscure smaller lesions, and digital subtraction angiography (DSA) remains the reference standard for detecting and subsequently tailoring an adequate etiological therapeutic strategy. 4,5 Whenever safe and feasible, magnetic resonance imaging (MRI) possibly represents the best noninvasive imaging modality for the acute diagnosis workup of pICH 5 and may provide arguments not to perform DSA, an invasive and irradiating technique. Advanced sequences such as arterial spin labeling (ASL), and time-resolved ("dynamic") 4-dimensional magnetic resonance angiography (4D-MRA) have been reported to be useful tool in the evaluation of AVS, but the role of these sequences at the acute phase of pICH is largely unexplored.…”

Neuroimaging in cerebellar ataxia in childhood: A review

“…In contrast to adults, hemorrhagic strokes account for about half of all strokes seen in children 43 . Trauma is the most common cause of intracranial hemorrhage in children, but the differentiation to spontaneous hemorrhage may be challenging 44 . Isolated trauma of the posterior fossa is rare.…”

“…Traumatic posterior fossa injury may also be accompanied by an epidural hematoma compressing the transverse and sigmoid sinus, possibly leading to sinus thrombosis including direct laceration of the dural sinus. Spontaneous intracranial hemorrhage is mostly caused by an underlying (congenital) vascular malformation (arteriovenous malformation, aneurysm, cavernous malformation, or arteriovenous fistula) 44 . Presenting symptoms may be nonspecific with headache, generalized or focal seizure, focal neurologic deficits, and signs of increased intracranial pressure with nausea, vomiting, and depressed levels of consciousness 45 .…”

“…43 Trauma is the most common cause of intracranial hemorrhage in children, but the differentiation to spontaneous hemorrhage may be challenging. 44 Isolated trauma of the posterior fossa is rare. If the cerebellum is affected, it is mainly seen in the context of severe trauma also involving the supratentorial region.…”

“…Spontaneous intracranial hemorrhage is mostly caused by an underlying (congenital) vascular malformation (arteriovenous malformation, aneurysm, cavernous malformation, or arteriovenous fistula). 44 Presenting symptoms may be nonspecific with headache, generalized or focal seizure, focal neurologic deficits, and signs of increased intracranial pressure with nausea, vomiting, and depressed levels of consciousness. 45 Ataxia may develop.…”