[Arterial ischemic stroke in the healthy child. Practical approach (neonate and foetus excluded)].
Primary stroke can be due to embolism or an obstructive process of the vascular wall. Embolism may come from a parietal lesion of a large artery in the neck (traumatic dissections), from a cryptic cardiopathy, from a venous thrombosis associated with a right-left shunt. Among pathologies of endocranial arteries, the most frequent is the acute, postviral arteriopathy of the sus-clinoïd carotid, which evolves toward stabilisation or regression. Insidious obstructive arteriopathies of the Willis circle, including development of a transparenchymal suppletive circulation (Moya-Moya disease), cumulate chronic circulatory insufficiency and repetitive strokes. Inflammatory multifocal cerebral arteriopathies mainly involve mean and small arteries. Most of them are secondary to a multisystemic disease, but some are primary. The basic investigation is anatomical and begins with MRI. Emergency conventional cerebral angiography is discussed when heparinotherapy is difficult to decide (evolutive thrombosis), or when an endovascular intervention appears possible (anoeuvrism). Secondarily, conventional angiography is indicated in any chronic situation where a precise anatomical follow-up is necessary. Investigations of the cardiovascular system, of the thrombophilic risk, of a dysimmune process are discussed according to the clinico-anatomical diagnosis.
Hernandez
L
L
Service de neurologie pédiatrique, CHU de Paris-Sud, hôpital Bicêtre, 78, avenue Gal-Leclerc, 94270 Le-Kremlin-Bicêtre, France.
Landrieu
P
P
Toulgoat
F
F
Lasjaunias
P
P
D001157:Arterial Occlusive Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging; D002533:Cerebral Angiography; D002648:Child; D002675:Child, Preschool; D006429:Hemiplegia / Q000209:etiology; D006801:Humans; D020766:Intracranial Embolism / Q000000981:diagnostic imaging; D020521:Stroke / Q000175:diagnosis* / Q000000981:diagnostic imaging