title: Radiological strategy in acute stroke in children.
abstract: The aim of the study was to estimate the preponderance of patterns of pediatric stroke, ischemic or hemorrhagic, their etiologies and the correct diagnostic protocol for acute management. Forty-one consecutive pediatric patients (age range 5-16 years) with an acute stroke observed in acute phase during a 10-year period, were retrospectively evaluated. Twenty-three patients underwent magnetic resonance imaging (MRI), 3 cases were studied by computed tomography (CT) without MRI, and 15 underwent both CT and MRI studies. In 9 cases, intra-arterial digital subtraction angiography (IADSA) was performed after non-invasive preliminary assessment. Seventeen hemorrhagic (41%) and 24 ischemic (59%) strokes were found. Among hemorrhagic forms, 5 cases were due to arteriovenous malformation (AVM), 7 to cavernoma, and 2 to aneurysm. Among ischemic forms, 2 were due to sickle-cell disease, 1 to hyperomocysteinemia, 1 to moyamoya syndrome, 1 to pseudoxantoma elasticum, 3 to prothrombotic state, 1 to Fabry's disease, 1 concomitant with CO intoxication, 5 to venous sinus thrombosis, and 4 to cardio-embolic state. Etiology remains unknown in 8 cases (20.5%). This study shows a moderate prevalence of ischemic over hemorrhagic strokes. Moreover, personal experience suggests that MRI is always more informative than CT and in selected cases should be the first-choice examination in the acute phase.
authors.affiliation: Dept. of Neuroradiology, University Hospital S. Salvatore, L'Aquila, Italy. apaonessa7@hotmail.com
authors.forename: Amalia
authors.initials: A
authors.lastname: Paonessa
authors.forename: Nicola
authors.initials: N
authors.lastname: Limbucci
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Tozzi
authors.forename: Alessandra
authors.initials: A
authors.lastname: Splendiani
authors.forename: Massimo
authors.initials: M
authors.lastname: Gallucci
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000209:etiology; D014057:Tomography, X-Ray Computed