Non-Atherosclerotic Vascular Disease in the Young

Abstract

There are a large variety of non-atherosclerotic causes of ischemic stroke in the young. Arterial dissection, most commonly associated with non-traumatic causes, is among the most common. Both the carotid and vertebrobasilar circulations can be affected. The vasculitidies represent a rare, but potentially treatable series of conditions that can lead to stroke through diverse mechanisms. Moyamoya is a nonatherosclerotic, noninflammatory, nonamyloid vasculopathy characterized by chronic progressive stenosis or occlusion of the distal internal carotid arteries and/or proximal portions of the middle and/or anterior cerebral arteries. Moyamoya can be idiopathic (moyamoya disease) or the result of other conditions. An appreciation of the unusual causes of stroke in the young is important when considering secondary prevention measures.

The Course of Unilateral Intracranial Arteriopathy in Young Adults With Arterial Ischemic Stroke

“…1 Improved availability and quality of noninvasive imaging of the extracranial and intracranial arteries has led to an increased frequency of patients with stroke diagnosed with arteriopathies, including dissection, moyamoya, angiitis, fibromuscular dysplasia, and postradiation vasculopathy. 2,3 In children, intracranial arteriopathies are found in approximately 53% of patients with AIS. 4 The recently published classification of childhood AIS, based on the childhood AIS standardized classification and diagnostic evaluation criteria, describes focal cerebral arteriopathy as a separate entity.…”

Spontaneous intracranial internal carotid artery dissection in a child with psoriasis

“…Spontaneous intracranial ICA dissections are considered rare and uncommon when compared with those of the vertebrobasilar system or the ICA's cervical portion that are mobile and more susceptible to mechanical factors in the pathogenesis of dissection [3][4][5] . However, in children than in adult, an intracranial ICA dissection is more commonly reported 1) .…”

“…Dissection of the internal carotid artery (ICA) is a cause of pediatric ischemic stroke, but not commonly reported [1][2][3] . Dissection of the ICA can occur spontaneously without an identified etiology or in the context of trauma or physical exertion as trivial as lifting a heavy object, coughing or straining during a bowel movement [2][3][4] .…”

“…Dissection of the ICA can occur spontaneously without an identified etiology or in the context of trauma or physical exertion as trivial as lifting a heavy object, coughing or straining during a bowel movement [2][3][4] . The etiology of spontaneous intracranial ICA dissection is not well understood, but environmental and genetic risk factors have been implicated [2][3][4][5] .…”

Etiology of intracranial stenosis in young patients: a high-resolution magnetic resonance imaging study

“…Atherosclerosis is the widely accepted underlying etiology, especially in old patients. In patients at a young age, however, intracranial stenosis has varied causes, such as dissection, moyamoya disease, fibromuscular dystrophy, and vasculitis (2)(3)(4). Current imaging techniques, including digital subtraction angiography, CT angiography, and magnetic resonance angiography (MRA) cannot provide direct proof of the casual etiology, because different pathologies can result in similar patterns of intracranial lumen stenosis.…”