Brainstem strokes in children: an 11-year series from a tertiary pediatric center.
METHODS
Potential clinical barriers to making a timely diagnosis of pediatric brainstem stroke and pitfalls of noninvasive vascular imaging are presented.


METHODS
An institutional review board-approved institutional database query from 2001-2012 yielded 15 patients with brainstem strokes. Medical records were reviewed for symptoms, stroke severity using the Pediatric National Institutes of Health Stroke Scale, and outcomes using the Pediatric Stroke Outcome Measure. Magnetic resonance angiography was compared with digital subtraction angiography.


RESULTS
There were 10 boys and five girls; 9 months to 17 years of age (mean 7.83 years). Symptoms were headaches (eight); visual problems (eight), seizure-like activity (seven), motor deficits (six), and decreased level of consciousness in four. Time since last seen well was 12 hours to 5 days. Pediatric National Institutes of Health Stroke Scale was 1-34; <10 in eight; 3 in 1, 10-20 in two, and >20 in four. Strokes were pontine in 13/15 and involved >50% of the pons in six and <50% in seven; 2/15 had medullary strokes. Magnetic resonance angiography showed basilar artery occlusion in 8/13 patients and vertebral artery dissection in two. Digital subtraction angiography done within 9-36 hours of magnetic resonance angiography in 10/15 patients confirmed the basilar artery occlusion seen by magnetic resonance angiography and showed vertebral artery dissection in four patients. Patients were systemically anticoagulated without hemorrhagic complications. One patient died. Pediatric Stroke Outcome Measures at 2-36 months is 0-5.0/10 (mean 1.25).


CONCLUSIONS
Vague symptoms contributed to delays in diagnosis. Magnetic resonance angiography was equivalent to digital subtraction angiography for basilar artery occlusion but not for vertebral artery dissection. Even with basilar artery occlusion and high stroke scales, outcome was good when systemic anticoagulation was started promptly.
Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address: Nancy.rollins@childrens.com.
Nancy
N
Rollins
Glen Lee
GL
Pride
Patricia A
PA
Plumb
Michael M
MM
Dowling
D000293:Adolescent; D001933:Brain Stem / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D010372:Pediatrics; D020521:Stroke / Q000473:pathology*
arterial dissection; brainstem stroke; digital subtraction angiography; magnetic resonance angiography (MRA); outcome; pediatric