Transient Focal Neurologic Symptoms Correspond to Regional Cerebral Hypoperfusion by MRI: A Stroke Mimic in Children

Abstract

Children who present with acute transient focal neurologic symptoms raise concern for stroke or transient ischemic attack. We present a series of 16 children who presented with transient focal neurologic symptoms that raised concern for acute stroke but who had no evidence of infarction and had unilateral, potentially reversible imaging features on vascular and perfusion-sensitive brain MR imaging. Patients were examined with routine brain MR imaging, MRA, perfusion-sensitive sequences, and DWI. Fourteen (88%) children had lateralized MRA evidence of arterial tree pruning without occlusion, all had negative DWI findings, and all showed evidence of hemispheric hypoperfusion by susceptibility-weighted imaging or arterial spin-labeling perfusion imaging at presentation. These findings normalized following resolution of symptoms in all children who had follow-up imaging (6/16, 38%). The use of MR imaging with perfusion-sensitive sequences, DWI, and MRA can help to rapidly distinguish children with conditions mimicking stroke from those with acute stroke.

Time Course of Cerebral Perfusion Changes in Children with Migraine with Aura Mimicking Stroke

“…This is earlier than described in other studies. [11][12][13] Each technique reviewed in this study provided data supporting the following pattern: apparent constriction of distal vessels on MRA, the presence of deoxygenated blood in cerebral veins on SWI, and initial hypoperfusion followed by a rebound hyperperfusion on ASL in the affected hemisphere. Patient 10 in this series demonstrated normal SWI and MRA findings and an ASL sequence with rCBF of only Ϫ0.4 at 4 hours, which may represent near-resolution of MR imaging perfusion changes or the transition from hypoperfusion to pseudonormalization during this patient's migraine.…”

“…Many studies have suggested the implementation of ASL in the evaluation of children presenting with focal neurologic symptoms, each with the finding of initial hypoperfusion followed by delayed hyperperfusion. [11][12][13][14] Boulouis et al 11 published a case series exploring the use of the ASL MR imaging sequence in children, which demonstrated decreased regional cerebral blood flow when obtained Ͻ14 hours after symptom onset and increased regional cerebral blood flow when obtained Ͼ17 hours after symptom onset. Lehman et al 12 hours after symptom onset.…”

“…[11][12][13][14] Boulouis et al 11 published a case series exploring the use of the ASL MR imaging sequence in children, which demonstrated decreased regional cerebral blood flow when obtained Ͻ14 hours after symptom onset and increased regional cerebral blood flow when obtained Ͼ17 hours after symptom onset. Lehman et al 12 hours after symptom onset. Pollock et al 14 similarly looked at a case series of 3 adults with migraine and noted cerebral hyperperfusion on ASL imaging Ͼ6 hours after the onset of neurologic symptoms.…”

“…Research has been published on the use of various MR imaging sequences to characterize the time course of perfusion changes in migraine, but there has previously been limited exploration of the simultaneous use of ASL, SWI, and MRA, particularly in pediatrics. [7][8][9][10][11][12][13][14] Our objective was to explore the use of multiple, noninvasive MR imaging sequences to better understand the relationship between clinical and MR imaging findings in pediatric hemiplegic migraine and migraine with aura.…”

Traumatic Brain Magnetic Resonance Imaging Feature Extraction Based on Variable Model Algorithm in Stroke Examination

“…The AUC area of the MR SCALE-PWI sequence in the diagnosis of ischemic penumbra was 0.933. This indicates that MR SCALE-PWI has a good effect on the early identification of ischemic penumbra, which can reduce unnecessary treatment and prolong the time window for patients to receive recanalization or neuroprotective treatment [ 25 ].…”