Current proceedings of childhood stroke

Abstract

Stroke is a sudden onset neurological deficit due to a cerebrovascular event. In children, the recognition of stroke is often delayed due to the low incidence of stroke and the lack of specific assessment measures to this entity. The causes of pediatric stroke are significantly different from that of adult stroke. The lack of safety and efficiency data in the treatment is the challenge while facing children with stroke. Nearly half of survivors of pediatric stroke may have neurologic deficits affecting functional status and quality of life. They may cause a substantial burden on health care resources. Hence, an accurate history, including onset and duration of symptoms, risk factors, and a complete investigation, including hematologic, neuroimaging, and metabolic studies is the key to make a corrective diagnosis. A prompt and optimal treatment without delay may minimize the damage to the brain.

Figure 1

A 17-year-old boy was presented with seizures one month after a prior head injury. Axial T1-weighted image (a) and coronal T2-weighted image (b) showed the hemosiderin deposition and a small CSF-filled cavity of the left middle frontal gyrus.

Figure 2

A 4-month-old infant was presented with a large head circumference followed by seizure-like episodes. Axial T2-weighted image (a) showed hydrocephalus and prominent CSF space along bilateral cerebral convexities. The fluid was subdural hematomas because the signal intensity of the fluid is different from that of CSF on FLAIR T2-weighted image (b). Coronal T2-weighted image showed hypoplasia of the left hippocampus.

Figure 3

A 17-year-old boy was presented with sudden loss of consciousness and generalized seizure attack. Nonenhanced CT study (a) showed acute intraventricular hemorrhage. CT angiography (b, c) disclosed occlusion of bilateral prebifurcation M1 segment of middle cerebral arteries with some moyamoya vessels (arrows).

Figure 4

A 15-year-old boy suddenly experienced acute right-sided headache and dizziness followed by drowsy consciousness and left-sided weakness after practicing backward somersaults. Nonenhanced CT image of the brain (a) showed increased attenuation at the M1 segment of the right MCA (white arrowhead). Apparent diffusion map of the brain (b) delineated a 2.4-cm low-signal area in the posterior limb of the right internal capsule, consistent with a hyperacute infarct (arrow). Magnetic resonance angiography of the brain (c) showed focal stenosis of the right MCA with decreased flow and number of distal branches (white arrowhead).