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. 2025 Jan 23;17(1):e77897.
doi: 10.7759/cureus.77897. eCollection 2025 Jan.

Clinical and Radiological Outcomes of Angiographically Proven Central Nervous System Arteriopathy

Javeria Raza Alvi  1 , Saher Gul Ahdi  1 , Narjis Fatima Alvi  2 , Muhammad Zia Ur Rehman  1 , Amna Tariq  3 , Tipu Sultan  1
Affiliations

Clinical and Radiological Outcomes of Angiographically Proven Central Nervous System Arteriopathy

Javeria Raza Alvi et al. Cureus. .

Abstract

Objective: Childhood stroke is a significant contributor to neurological morbidity often leading to debilitating outcomes. This study aimed to assess the clinical and radiological outcomes of angiographically proven central nervous system (CNS) arteriopathy in children.

Material and methods: This prospective cohort study was conducted from June 2023 to May 2024 at The Children's Hospital, Lahore, Pakistan. The clinical outcomes were assessed using the Pediatric National Institute of Health Stroke Scale (PedNIHSS) at baseline and compared at six-month follow-up, while radiological outcomes were categorized as stable, regressive, or progressive disease. Clinical presentation, etiology, baseline PedNIHSS score, and arterial involvement were correlated with motor outcomes.

Results: Out of the 38 patients, 63.2% were female patients with a mean age of 4.27±2.43 years. The most common age group was 2-5 years (50.0%), followed by >5-10 years (31.6%). Global clinical presentation was seen in 60.5%, while 29.0% had a recurrence of stroke. Moyamoya disease (21.1%) was the most common etiological factor, followed by primary CNS angiitis (13.0%), infections (8.0%), and post-varicella focal cerebral arteriopathy (8.0%). Bilateral infarcts (55.3%) and anterior circulation involvement (68.4%) were the most affected areas, with the middle cerebral artery (MCA) being the most affected with complete involvement in 18.4% and partial involvement in 81.5% of cases. The mean baseline PedNIHSS score was 29±6.4, which improved to 19±4.8 at the six-month follow-up. Radiological outcomes showed in 42.2% of cases, with a progression of the disease on follow-up MRA; 31.6% had stable disease, while 21.0% had regressive disease. Significant factors associated with poor motor outcomes included global presentation (p=0.000008), etiological factors (p=0.047), bilateral infarcts (p=0.050), severe baseline PedNIHSS (p=0.000019), and progressive radiological disease (p=0.003).

Conclusion: This study highlights the significant neurological impact of pediatric stroke. Early diagnosis, investigation of underlying causes, and identification of recurrence risk factors are crucial in preventing immediate and long-term complications.

Keywords: arterial ischemic stroke; childhood stroke; magnetic resonance angiography; motor outcome; moyamoya disease.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Institutional Review Board Committee, The Children's Hospital and The Institute of Child Health, Lahore, Pakistan issued approval 2021-414 CHICH. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. A breakdown of etiological factors
CNS: Central nervous system The figure was derived from the statistical analyses conducted by the authors.
Figure 2
Figure 2. PedNIHSS category at baseline and six-month follow up
PedNIHSS: Pediatric National Institutes of Health Stroke Scale The figure was derived from the statistical analyses conducted by the authors.
Figure 3
Figure 3. Mean clinical motor outcomes across various etiologies (left) and a histogram of regression standardized residuals for clinical motor outcomes (right)
The figure was derived from the statistical analyses conducted by the authors.
See this image and copyright information in PMC

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