title: Pathways for Neuroimaging of Neonatal Stroke.
abstract: To provide consensus-based, suggested imaging protocols to facilitate the accurate and timely diagnosis of a neonate with symptoms concerning for stroke.
  
  
  
  The Writing Group, an international collaboration of pediatric neurologists and neuroradiologists with expertise in perinatal and childhood stroke, participated in a series of pediatric stroke neuroimaging symposia. These discussions, in conjunction with extensive literature review, led to a consensus for imaging protocols to guide practitioners in the diagnosis of neonatal stroke subtypes as defined by the National Institute of Neurological Disorders and Stroke Common Data Elements. The epidemiology, clinical presentation, and associated risk factors for arterial ischemic stroke, cerebral sinovenous thrombosis, and hemorrhagic stroke are reviewed, with a focused discussion regarding the role of neuroimaging for each subtype.
  
  
  
  In a neonate with suspected stroke, magnetic resonance imaging is the preferred modality, given the lack of X-irradiation, superior anatomic resolution, and sensitivity for acute ischemia. Core recommended sequences include diffusion-weighted imaging and apparent diffusion coefficient mapping to diagnose acute ischemia, gradient-recalled echo or susceptibility-weighted imaging to detect intracranial blood and its breakdown products, and T1- and T2-weighted imaging to assess for myelination, extra-axial blood, and edema. Magnetic resonance angiography of the brain may be useful to detect vascular abnormalities, with venography if venous sinus thrombosis is suspected. The application of more novel sequences, as well as the utility of follow up-imaging, is also discussed.
authors.affiliation: Department of Neurology & Neurological Sciences, Stanford Hospital and Clinics, Stanford School of Medicine, Stanford, California. Electronic address: slee10@stanford.edu.
authors.forename: Sarah
authors.initials: S
authors.lastname: Lee
authors.affiliation: Department of Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: David M
authors.initials: DM
authors.lastname: Mirsky
authors.affiliation: Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Lauren A
authors.initials: LA
authors.lastname: Beslow
authors.affiliation: Department of Neurology, Seattle Children's Hospital, University of Washington, Seattle, Washington.
authors.forename: Catherine
authors.initials: C
authors.lastname: Amlie-Lefond
authors.affiliation: Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Amy R
authors.initials: AR
authors.lastname: Danehy
authors.affiliation: Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Laura
authors.initials: L
authors.lastname: Lehman
authors.affiliation: Department of Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Nicholas V
authors.initials: NV
authors.lastname: Stence
authors.affiliation: Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Arastoo
authors.initials: A
authors.lastname: Vossough
authors.affiliation: Division of Neuroradiology, Department of Radiology, Stanford University School of Medicine, Stanford, California.
authors.forename: Max
authors.initials: M
authors.lastname: Wintermark
authors.affiliation: Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, Boston, Massachuetts.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Rivkin
mesh_terms: D001921:Brain / Q000000981:diagnostic imaging*; D006801:Humans; D007231:Infant, Newborn; D059906:Neuroimaging / Q000379:methods; D020521:Stroke / Q000145:classification / Q000000981:diagnostic imaging*
keywords: computed tomography; cranial ultrasound; magnetic resonance imaging; neuroimaging; perinatal stroke