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Título

NEUROIMAGING OF PEDIATRIC ARTERIAL STROKE

Introdução e objetivo(s)

Pediatric stroke is a cerebrovascular event occurring between 28 days of life and 18 years, leading to neurological deficits due to disrupted cerebral blood flow. Although less common than in adults, it remains a significant cause of acquired brain injury in children. Early recognition is crucial to minimizing long-term neurological sequelae. This study aims to review the neuroradiological aspects of pediatric stroke, emphasizing imaging findings and their role in diagnosis and management.

Método(s)

Pictorial essay and case review of pediatric stroke cases, highlighting different clinical scenarios with corresponding imaging studies.

Discussão

Pediatric stroke is classified as ischemic or hemorrhagic. Arterial ischemic stroke (AIS) results from vascular obstruction, while hemorrhagic stroke involves bleeding into brain tissue. Unlike in adults, pediatric stroke etiologies include congenital heart disease, sickle cell disease, infections, trauma, and arteriopathies.
Neuroimaging is essential for diagnosis and management. MRI is the preferred modality due to its superior soft-tissue contrast and ability to detect acute and chronic infarcts. Diffusion-weighted imaging (DWI) is particularly useful for identifying early ischemic injury before conventional sequences show abnormalities. Magnetic resonance angiography (MRA) and computed tomography angiography (CTA) assess vascular integrity, detecting arterial stenosis, dissection, or occlusion, and evaluating collateral circulation. In pediatrics, the causes of ischemia vary beyond embolic etiologies, which may be related to cardiopathy. Other causes, such as arteriopathy (divided into inflammatory and non-inflammatory types) and genetically determined diseases, should be investigated in the context of childhood stroke
For hemorrhagic stroke, non-contrast CT is the first-line imaging tool due to its speed and sensitivity to acute hemorrhage. However, MRI provides better lesion characterization, particularly in vascular malformations such as arteriovenous malformations (AVMs) or moyamoya disease. Digital subtraction angiography (DSA) remains the gold standard for detailed vascular assessment, especially in cases where endovascular intervention is considered.

Conclusões

Pediatric stroke is a complex condition with diverse etiologies and significant long-term consequences. A multidisciplinary approach integrating neurology, radiology, and interventional specialties is crucial for optimal management. Advanced neuroimaging techniques enable early diagnosis, accurate classification, and improved treatment strategies, ultimately enhancing outcomes and reducing neurological sequelae.

Palavras Chave

PEDIATRIC STROKE

Arquivos