1
|
Egashira S, Tanaka T, Yamashiro T, Saito S, Abe S, Yoshimoto T, Fukuma K, Ishiyama H, Yamaguchi E, Hattori Y, Ogata S, Nishimura K, Koga M, Toyoda K, Debette S, Ihara M. High pillow and spontaneous vertebral artery dissection: A case-control study implicating "Shogun pillow syndrome". Eur Stroke J 2024; 9:501-509. [PMID: 38284382 DOI: 10.1177/23969873231226029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024] Open
Abstract
INTRODUCTION The underlying causes of spontaneous vertebral artery dissection (sVAD) remain insufficiently understood. This study aimed to determine whether high-pillow usage is associated with an increased risk of sVAD and evaluate the frequency of sVAD attributable to high-pillow usage. PATIENTS AND METHODS This case-control study identified patients with sVAD and age- and sex-matched non-sVAD controls (case-to-control ratio: 1:1) treated at a certified comprehensive stroke center in Japan between 2018 and 2023. The pillow height used at the onset of the index disease was measured and classified into three categories between 12 and 15 cm boundaries. Univariable logistic regression was performed to assess the odds ratio (OR) with a 95% confidence interval (CI) of high-pillow usage for sVAD development. A subgroup of sVAD attributable to high-pillow usage was defined with the following three conditions: high-pillow usage (⩾12 or ⩾15 cm); no minor preceding trauma; and wake-up onset. RESULTS Fifty-three patients with sVAD and 53 non-sVAD controls (42% women, median age: 49 years) were identified. High-pillow usage (⩾12 and ⩾15 cm) was more common in the sVAD group than in the non-sVAD group (34 vs 15%; OR = 2.89; 95%CI = 1.13-7.43 and 17 vs 1.9%; OR = 10.6; 95%CI = 1.30-87.3, respectively). The subgroup of sVAD attributed to high-pillow usage (⩾12 and ⩾15 cm) was found in 11.3% (95%CI = 2.7%-19.8%) and 9.4% (95%CI = 1.5%-17.3%), respectively. CONCLUSION High-pillow usage was associated with an increased risk of sVAD and accounted for approximately 10% of all sVAD cases. This tentative subgroup of sVAD may represent a distinct spectrum of disease-Shogun pillow syndrome.
Collapse
Affiliation(s)
- Shuhei Egashira
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Tomotaka Tanaka
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Takayuki Yamashiro
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Satoshi Saito
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Soichiro Abe
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Takeshi Yoshimoto
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kazuki Fukuma
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hiroyuki Ishiyama
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Eriko Yamaguchi
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yorito Hattori
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Soshiro Ogata
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kunihiro Nishimura
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Stéphanie Debette
- Department of Neurology, Bordeaux University Hospital, Bordeaux, France
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| |
Collapse
|
2
|
Little SB, Sarma A, Bajaj M, Pruthi S, Reddy K, Reisner A, Philbrook B, Jordan LC. Imaging of Vertebral Artery Dissection in Children: An Underrecognized Condition with High Risk of Recurrent Stroke. Radiographics 2023; 43:e230107. [PMID: 37971932 DOI: 10.1148/rg.230107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Vertebral artery dissection (VAD) is a common cause of a rare condition, pediatric posterior circulation arterial ischemic stroke (PCAIS). VAD is clinically important due to the risk of multifocal and continuing infarcts from artery-to-artery thromboembolism, with the potential for occlusion of arteries that perfuse the brainstem. Early diagnosis is important, as recurrent stroke is a common effect of VAD in children. Although the relative efficacies of different treatment regimens for VAD in children remain unsettled, early initiation of treatment can mitigate the risk of delayed stroke. Clinical diagnosis of PCAIS may be delayed due to multiple factors, including nonspecific symptoms and the inability of younger patients to express symptoms. In fact, subacute or chronic infarcts are often present at initial imaging. Although the most common cause of isolated PCAIS is VAD, imaging of the cervical arteries has been historically underused in this setting. Cervical vascular imaging (MR angiography, CT angiography, and digital subtraction angiography) for VAD must be optimized to detect the sometimes subtle findings, which may be identified at initial or follow-up imaging. Osseous variants of the craniocervical junction and upper cervical spine and other extrinsic lesions that may directly injure the vertebral arteries or lead to altered biomechanics have been implicated in some cases. The authors review characteristic imaging features and optimized imaging of VAD and associated PCAIS and related clinical considerations. Identification of VAD has important implications for evaluation, treatment, and imaging follow-up, as this condition may result in progressive arteriopathy and recurrent stroke. © RSNA, 2023 Supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center.
Collapse
Affiliation(s)
- Stephen B Little
- From the Departments of Radiology (S.B.L., M.B., K.R.), Neurosurgery and Pediatrics (A.R.), and Pediatrics-Child Neurology (B.P.), Children's Healthcare of Atlanta, Emory University, Atlanta, GA; and Departments of Radiology (A.S., S.P.) and Pediatrics (L.C.J.), Vanderbilt University Medical Center, Monroe Carell Jr Children's Hospital, 2200 Children's Way, Nashville, TN 37323
| | - Asha Sarma
- From the Departments of Radiology (S.B.L., M.B., K.R.), Neurosurgery and Pediatrics (A.R.), and Pediatrics-Child Neurology (B.P.), Children's Healthcare of Atlanta, Emory University, Atlanta, GA; and Departments of Radiology (A.S., S.P.) and Pediatrics (L.C.J.), Vanderbilt University Medical Center, Monroe Carell Jr Children's Hospital, 2200 Children's Way, Nashville, TN 37323
| | - Manish Bajaj
- From the Departments of Radiology (S.B.L., M.B., K.R.), Neurosurgery and Pediatrics (A.R.), and Pediatrics-Child Neurology (B.P.), Children's Healthcare of Atlanta, Emory University, Atlanta, GA; and Departments of Radiology (A.S., S.P.) and Pediatrics (L.C.J.), Vanderbilt University Medical Center, Monroe Carell Jr Children's Hospital, 2200 Children's Way, Nashville, TN 37323
| | - Sumit Pruthi
- From the Departments of Radiology (S.B.L., M.B., K.R.), Neurosurgery and Pediatrics (A.R.), and Pediatrics-Child Neurology (B.P.), Children's Healthcare of Atlanta, Emory University, Atlanta, GA; and Departments of Radiology (A.S., S.P.) and Pediatrics (L.C.J.), Vanderbilt University Medical Center, Monroe Carell Jr Children's Hospital, 2200 Children's Way, Nashville, TN 37323
| | - Kartik Reddy
- From the Departments of Radiology (S.B.L., M.B., K.R.), Neurosurgery and Pediatrics (A.R.), and Pediatrics-Child Neurology (B.P.), Children's Healthcare of Atlanta, Emory University, Atlanta, GA; and Departments of Radiology (A.S., S.P.) and Pediatrics (L.C.J.), Vanderbilt University Medical Center, Monroe Carell Jr Children's Hospital, 2200 Children's Way, Nashville, TN 37323
| | - Andrew Reisner
- From the Departments of Radiology (S.B.L., M.B., K.R.), Neurosurgery and Pediatrics (A.R.), and Pediatrics-Child Neurology (B.P.), Children's Healthcare of Atlanta, Emory University, Atlanta, GA; and Departments of Radiology (A.S., S.P.) and Pediatrics (L.C.J.), Vanderbilt University Medical Center, Monroe Carell Jr Children's Hospital, 2200 Children's Way, Nashville, TN 37323
| | - Bryan Philbrook
- From the Departments of Radiology (S.B.L., M.B., K.R.), Neurosurgery and Pediatrics (A.R.), and Pediatrics-Child Neurology (B.P.), Children's Healthcare of Atlanta, Emory University, Atlanta, GA; and Departments of Radiology (A.S., S.P.) and Pediatrics (L.C.J.), Vanderbilt University Medical Center, Monroe Carell Jr Children's Hospital, 2200 Children's Way, Nashville, TN 37323
| | - Lori C Jordan
- From the Departments of Radiology (S.B.L., M.B., K.R.), Neurosurgery and Pediatrics (A.R.), and Pediatrics-Child Neurology (B.P.), Children's Healthcare of Atlanta, Emory University, Atlanta, GA; and Departments of Radiology (A.S., S.P.) and Pediatrics (L.C.J.), Vanderbilt University Medical Center, Monroe Carell Jr Children's Hospital, 2200 Children's Way, Nashville, TN 37323
| |
Collapse
|
3
|
Kim M, Subah G, Cooper J, Fortunato M, Nolan B, Bowers C, Prabhakaran K, Nuoman R, Amuluru K, Soldozy S, Das AS, Regenhardt RW, Izzy S, Gandhi C, Al-Mufti F. Neuroendovascular Surgery Applications in Craniocervical Trauma. Biomedicines 2023; 11:2409. [PMID: 37760850 PMCID: PMC10525707 DOI: 10.3390/biomedicines11092409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/12/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023] Open
Abstract
Cerebrovascular injuries resulting from blunt or penetrating trauma to the head and neck often lead to local hemorrhage and stroke. These injuries present with a wide range of manifestations, including carotid or vertebral artery dissection, pseudoaneurysm, occlusion, transection, arteriovenous fistula, carotid-cavernous fistula, epistaxis, venous sinus thrombosis, and subdural hematoma. A selective review of the literature from 1989 to 2023 was conducted to explore various neuroendovascular surgical techniques for craniocervical trauma. A PubMed search was performed using these terms: endovascular, trauma, dissection, blunt cerebrovascular injury, pseudoaneurysm, occlusion, transection, vasospasm, carotid-cavernous fistula, arteriovenous fistula, epistaxis, cerebral venous sinus thrombosis, subdural hematoma, and middle meningeal artery embolization. An increasing array of neuroendovascular procedures are currently available to treat these traumatic injuries. Coils, liquid embolics (onyx or n-butyl cyanoacrylate), and polyvinyl alcohol particles can be used to embolize lesions, while stents, mechanical thrombectomy employing stent-retrievers or aspiration catheters, and balloon occlusion tests and super selective angiography offer additional treatment options based on the specific case. Neuroendovascular techniques prove valuable when surgical options are limited, although comparative data with surgical techniques in trauma cases is limited. Further research is needed to assess the efficacy and outcomes associated with these interventions.
Collapse
Affiliation(s)
- Michael Kim
- Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY 10595, USA
| | - Galadu Subah
- Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY 10595, USA
| | - Jared Cooper
- Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY 10595, USA
| | - Michael Fortunato
- Department of Neurology, Westchester Medical Center at New York Medical College, Valhalla, NY 10595, USA
| | - Bridget Nolan
- Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY 10595, USA
| | - Christian Bowers
- Department of Neurosurgery, University of New Mexico, Albuquerque, NM 87108, USA
| | - Kartik Prabhakaran
- Department of Surgery, Division of Trauma and Acute Care Surgery, Westchester Medical Center at New York Medical College, Valhalla, NY 10595, USA
| | - Rolla Nuoman
- Department of Neurology, Maria Fareri Children’s Hospital, Westchester Medical Center at New York Medical College, Valhalla, NY 10595, USA
| | - Krishna Amuluru
- Goodman Campbell Brain and Spine, Indianapolis, IN 46032, USA
| | - Sauson Soldozy
- Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY 10595, USA
| | - Alvin S. Das
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Robert W. Regenhardt
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02215, USA
| | - Saef Izzy
- Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02215, USA
| | - Chirag Gandhi
- Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY 10595, USA
| | - Fawaz Al-Mufti
- Department of Neurology, Westchester Medical Center at New York Medical College, Valhalla, NY 10595, USA
| |
Collapse
|
4
|
Schulz M, Weihing V, Shah MN, Cox CS, Ugalde I. Risk factors for blunt cerebrovascular injury in the pediatric patient: A systematic review. Am J Emerg Med 2023; 71:37-46. [PMID: 37327710 DOI: 10.1016/j.ajem.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/25/2023] [Accepted: 06/03/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND While blunt cerebrovascular injury (BCVI) is a rare complication of blunt trauma, it is associated with significant morbidity and mortality. In the pediatric population, unique anatomy and development require screening criteria that accurately diagnose these injuries while limiting unwarranted radiation. METHODS We searched Medline OVID, EMBASE, and Cochrane Library databases for studies that investigated the risk factors of BCVI in individuals younger than 18 years of age. We adhered to the Preferred Reporting Items in Systematic Reviews and Meta-Analyses (PRISMA) guidelines and assessed the quality of each study using the Newcastle-Ottawa Scale. We compared key characteristics of the papers, including incidence of BCVI, incidence of risk factors, and statistical significance of risk factors. RESULTS Of 1304 studies, 16 met the inclusion criteria. Of these, 15 were retrospective cohort studies and one was a retrospective case control study. Most of the studies included all pediatric blunt trauma admissions, but four only included those which underwent imaging, one only included those with cervical seatbelt sign, and one excluded those who did not survive 24-h post-admission. The ages included as pediatric varied between papers. Papers examined different risk factors and reported differing statistical significances. Though no single risk factor was found to be statistically significant in every study, cervical spine and skull fractures were found to be significant by most. Maxillofacial fractures, depressed GCS score, and stroke were found to be statistically significant by multiple studies. Twelve studies examined cervical soft tissue injury, and none found it to be statistically significant. CONCLUSIONS The risk factors most found to be statistically significant for BCVI were cervical spine fracture (10/16 studies), skull fracture (9/16), maxillofacial fractures (7/16), depressed GCS score (5/16), and stroke (5/16). There is a need for prospective studies on this topic. LEVEL OF EVIDENCE Level III, Systematic Review.
Collapse
Affiliation(s)
- Madison Schulz
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 361-947-1354, USA.
| | - Veronica Weihing
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA.
| | - Manish N Shah
- Division of Pediatric Neurosurgery, Department of Pediatric Surgery, McGovern Medical School, The University of Texas Health Science Center, Houston, Houston, TX, USA.
| | - Charles S Cox
- Department of Pediatric Surgery, McGovern Medical School, The University of Texas Health Science Center, Houston, Houston, TX, USA.
| | - Irma Ugalde
- Department of Emergency Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA.
| |
Collapse
|
5
|
Sun LR, Lynch JK. Advances in the Diagnosis and Treatment of Pediatric Arterial Ischemic Stroke. Neurotherapeutics 2023; 20:633-654. [PMID: 37072548 PMCID: PMC10112833 DOI: 10.1007/s13311-023-01373-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2023] [Indexed: 04/20/2023] Open
Abstract
Though rare, stroke in infants and children is an important cause of mortality and chronic morbidity in the pediatric population. Neuroimaging advances and implementation of pediatric stroke care protocols have led to the ability to rapidly diagnose stroke and in many cases determine the stroke etiology. Though data on efficacy of hyperacute therapies, such as intravenous thrombolysis and mechanical thrombectomy, in pediatric stroke are limited, feasibility and safety data are mounting and support careful consideration of these treatments for childhood stroke. Recent therapeutic advances allow for targeted stroke prevention efforts in high-risk conditions, such as moyamoya, sickle cell disease, cardiac disease, and genetic disorders. Despite these exciting advances, important knowledge gaps persist, including optimal dosing and type of thrombolytic agents, inclusion criteria for mechanical thrombectomy, the role of immunomodulatory therapies for focal cerebral arteriopathy, optimal long-term antithrombotic strategies, the role of patent foramen ovale closure in pediatric stroke, and optimal rehabilitation strategies after stroke of the developing brain.
Collapse
Affiliation(s)
- Lisa R Sun
- Divisions of Pediatric Neurology and Cerebrovascular Neurology, Department of Neurology, Johns Hopkins University School of Medicine, 200 N. Wolfe Street, Ste 2158, Baltimore, MD, 21287, USA.
| | - John K Lynch
- Acute Stroke Research Section, Stroke Branch (SB), National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| |
Collapse
|
6
|
Jay CRG, Duncan AN, Ellika SK, Bender MT. Stents for progressively symptomatic paediatric intracranial arterial dissection. J Neurointerv Surg 2023; 15:e3. [PMID: 34103356 DOI: 10.1136/neurintsurg-2021-017464.rep] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/12/2021] [Accepted: 04/14/2021] [Indexed: 11/04/2022]
Abstract
Arterial dissection is an uncommon cause of paediatric stroke. Medical therapy remains first-line for treatment. There are few reports of neurovascular stents for paediatric intracranial arterial dissection. Two adolescents presented with neurological deficits and CT angiography concerning for supraclinoid internal carotid artery stenosis. The diagnosis of dissection was secured through a combination of vessel wall MRI and digital subtraction angiography. The patients experienced progressive ischaemic symptoms, despite medical management including anticoagulation, and required stenting. The stents used were a Neuroform EZ and an Atlas. Both patients recovered to Modified Rankin Scale (mRS) 0 and had restored vessel calibre on 6-month follow-up digital subtraction angiography. Neurovascular stents can be used to treat progressively symptomatic intracranial arterial dissections in the paediatric population if medical therapy fails.
Collapse
Affiliation(s)
- Catherine R G Jay
- Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Aubrey N Duncan
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - Shehanaz K Ellika
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York, USA
| | - Matthew T Bender
- Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA
| |
Collapse
|
7
|
Shimizu H, Ono T, Abe T, Hokari M, Egashira Y, Shimonaga K, Kawanishi M, Nomura K, Takahashi Y. Current Treatment Results of Intracranial Carotid Artery Dissection Causing Cerebral Ischemia: A Japanese Nationwide Survey. Neurol Med Chir (Tokyo) 2023; 63:80-89. [PMID: 36599430 PMCID: PMC9995147 DOI: 10.2176/jns-nmc.2022-0249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Intracranial carotid artery dissection causing cerebral ischemia is a rare but important cause of cerebral infarction in children and adolescents. Although endovascular therapy has been reported to be effective, questions regarding the indications for intervention are yet to be addressed. Therefore, this study aimed to evaluate factors related to clinical outcomes through a nationwide survey. Overall, 35 neurosurgical centers reported patients within 2 weeks after ischemic onset due to intracranial carotid artery dissection causing cerebral ischemia treated between January 2015 and December 2020. Data on clinical and radiological findings were statistically analyzed. Twenty-eight patients met the inclusion criteria. The median age was 36 years (range, 7-59 years), without sex differences. Headache at onset was documented in 60.7% of the patients. Dissection findings were categorized into stenosis (71.4%) or occlusion (28.6%). Initial treatments, including various antithrombotic agent combinations in 23 (82.1%) patients, effectively improved or prevented aggravation in half of the patients. The patients with stenotic dissection were significantly more likely to experience aggravation during the initial treatment than did those with occlusive dissection (P = 0.03). In addition, the patients with moderate to severe neurological deficits on admission had poorer outcomes at discharge more frequently than did those with mild neurological deficits on admission. Eight patients undergoing endovascular therapy had no procedural complications or further aggravation after intervention. In conclusion, patients with intracranial carotid dissection causing cerebral ischemia who had a stenotic dissection were at risk of further aggravation, and endovascular therapy effectively improved or prevented aggravation.
Collapse
Affiliation(s)
- Hiroaki Shimizu
- Department of Neurosurgery, Akita University Graduate School of Medicine
| | - Takahiro Ono
- Department of Neurosurgery, Akita University Graduate School of Medicine
| | - Takatsugu Abe
- Department of Neurosurgery, Akita University Graduate School of Medicine
| | | | - Yusuke Egashira
- Department of Neurosurgery, Gifu University Graduate School of Medicine
| | - Koji Shimonaga
- Department of Neurosurgery, National Cerebral and Cardiovascular Center
| | - Masahiko Kawanishi
- Department of Neurological Surgery, Faculty of Medicine, Kagawa University
| | - Kyoko Nomura
- Department of Environmental Health Science and Public Health, Akita University Graduate School of Medicine
| | - Yusuke Takahashi
- Department of Neurosurgery, Akita University Graduate School of Medicine
| |
Collapse
|
8
|
Hanalioglu D, Oncel I, Hanalioglu S, Cebeci D, Kurt F, Gunes A, Gurkas E. Interplay between carotid artery dissection and thrombophilia leading to ischaemic stroke after minor head trauma in an adolescent: a case report. Paediatr Int Child Health 2023; 43:13-18. [PMID: 37849317 DOI: 10.1080/20469047.2023.2269362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 10/06/2023] [Indexed: 10/19/2023]
Abstract
Stroke in children is more common than is often realised; there are numerous potential causes, including carotid artery injury resulting from minor head or neck trauma, as well as genetic conditions associated with thrombophilia. A 13-year-old boy suffered an arterial ischaemic stroke (AIS) secondary to dissection of the left internal carotid artery (ICA) after he headed the ball during a game of football. He presented with generalised tonic-clonic seizure, loss of consciousness, right-sided hemiplegia and aphasia. Neuroradiological imaging showed left caudate, putaminal and posterior insular ischaemic infarct secondary to complete occlusion of the left ICA and accompanying partial left middle cerebral artery occlusion. He was treated with anticoagulant and anti-aggregant agents. Rarely, minor head trauma can result in internal carotid artery dissection, thrombus formation and arterial occlusion, leading to arterial ischaemic stroke. Prompt diagnosis and management are crucial to achieve a good neurological outcome.Abbreviations: AIS: arterial ischaemic stroke; ANA: anti-nuclear antibody; APA: anti-phospholipid antibody; APTT: activated partial thromboplastin time; CAD: carotid artery dissection; CCAD: cranio-cervical artery dissection; CRP: C-reactive protein; CT: computed tomography; CTA: computed tomography angiography; dsDNA: double-stranded DNA; ESR: erythrocyte sedimentation rate; ICA: internal carotid artery; LA: lupus anticoagulant; MCA: middle cerebral artery; MRA: magnetic resonance angiography; MRI: magnetic resonance imaging; MTHFR: methylenetetrahydrofolate reductase; PT INR: prothrombin time international normalised ratio.
Collapse
Affiliation(s)
- Damla Hanalioglu
- Department of Paediatrics, Division of Paediatric Emergency Medicine, University of Health Sciences, Ankara, Turkey
- Department of Paediatrics, Division of Paediatric Emergency Medicine, Hacettepe University Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Ibrahim Oncel
- Department of Paediatrics, Division of Paediatric Neurology, University of Health Sciences, Ankara, Turkey
| | - Sahin Hanalioglu
- Department of Neurosurgery, University of Health Sciences, Ankara, Turkey
| | - Dilek Cebeci
- Department of Paediatrics, Division of Paediatric Neurology, University of Health Sciences, Ankara, Turkey
| | - Funda Kurt
- Department of Paediatrics, Division of Paediatric Emergency Medicine, University of Health Sciences, Ankara, Turkey
| | - Altan Gunes
- Department of Radiology, University of Health Sciences, Ankara, Turkey
| | - Esra Gurkas
- Department of Paediatrics, Division of Paediatric Neurology, University of Health Sciences, Ankara, Turkey
| |
Collapse
|
9
|
Mathew BA, Katta M, Ludhiadch A, Singh P, Munshi A. Role of tRNA-Derived Fragments in Neurological Disorders: a Review. Mol Neurobiol 2023; 60:655-671. [PMID: 36348262 DOI: 10.1007/s12035-022-03078-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 10/05/2022] [Indexed: 11/10/2022]
Abstract
tRFs are small tRNA derived fragments that are emerging as novel therapeutic targets and regulatory molecules in the pathophysiology of various neurological disorders. These are derived from precursor or mature tRNA, forming different subtypes that have been reported to be involved in neurological disorders like stroke, Alzheimer's, epilepsy, Parkinson's, MELAS, autism, and Huntington's disorder. tRFs were earlier believed to be random degradation debris of tRNAs. The significant variation in the expression level of tRFs in disease conditions indicates their salient role as key players in regulation of these disorders. Various animal studies are being carried out to decipher their exact role; however, more inputs are required to transform this research knowledge into clinical application. Future investigations also call for high-throughput technologies that could help to bring out the other hidden aspects of these entities. However, studies on tRFs require further research efforts to overcome the challenges posed in quantifying tRFs, their interactions with other molecules, and the exact mechanism of function. In this review, we are abridging the current understanding of tRFs, including their biogenesis, function, relevance in clinical therapies, and potential as diagnostic and prognostic biomarkers of these neurological disorders.
Collapse
Affiliation(s)
- Blessy Aksa Mathew
- Complex Disease Genomics and Precision Medicine Laboratory, Department of Human Genetics and Molecular Medicine, Central University of Punjab, Bathinda, India, 151401
| | - Madhumitha Katta
- Complex Disease Genomics and Precision Medicine Laboratory, Department of Human Genetics and Molecular Medicine, Central University of Punjab, Bathinda, India, 151401
| | - Abhilash Ludhiadch
- Complex Disease Genomics and Precision Medicine Laboratory, Department of Human Genetics and Molecular Medicine, Central University of Punjab, Bathinda, India, 151401
| | - Paramdeep Singh
- Department of Radiology, All India Institute of Medical Sciences, Bathinda, Punjab, India, 151001
| | - Anjana Munshi
- Complex Disease Genomics and Precision Medicine Laboratory, Department of Human Genetics and Molecular Medicine, Central University of Punjab, Bathinda, India, 151401.
| |
Collapse
|
10
|
Persa L, Shaw DW, Amlie-Lefond C. Why Would a Child Have a Stroke? J Child Neurol 2022; 37:907-915. [PMID: 36214173 DOI: 10.1177/08830738221129916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Identifying the etiology of childhood arterial ischemic stroke helps prevent stroke recurrence. In addition, stroke may herald a serious underlying condition requiring treatment, such as acquired heart disease, malignancy, or autoimmune disorder. Evidence-based guidelines exist for adults to identify and treat common risk factors for primary and secondary stroke, including hypertension, diabetes, elevated lipids, atrial fibrillation, and sleep apnea, which are rarely relevant in children. However, guidelines do not exist in pediatrics. Identifying the cause of childhood stroke may be straightforward or may require extensive clinical and neuroimaging expertise, serial evaluations, and reassessment based on the evolving clinical picture. Risk factors may be present but not necessarily causative, or not causative until a triggering event such as infection or anemia occurs. Herein, we describe strategies to determine stroke etiology, including challenges and potential pitfalls.
Collapse
Affiliation(s)
- Laurel Persa
- Department of Neurology, 7274Seattle Children's Hospital, Seattle, Washington, USA
| | - Dennis Ww Shaw
- Department of Radiology, 7274Seattle Children's Hospital, Seattle, Washington, USA
| | | |
Collapse
|
11
|
Karaman AK, Korkmazer B, Arslan S, Kızılkılıç O, Koçer N, Islak C. Spontaneous internal carotid artery dissection in a child diagnosed by high resolution vessel wall MRI. Childs Nerv Syst 2022; 39:1101-1105. [PMID: 36369383 DOI: 10.1007/s00381-022-05745-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 11/03/2022] [Indexed: 11/13/2022]
Abstract
Craniocervical dissection is one of the most common causes of stroke in children. Although the most common cause of dissection is trauma, spontaneous dissections in which no cause can be revealed may also occur. The diagnosis of this type of dissection in children can be challenging with the preferred non-invasive imaging methods (MRA, CTA). Intracranial vessel wall imaging is a promising novel method for identifying specific signs of dissection. We report an 11-year-old girl with spontaneous ICA dissection, whose diagnosis was confirmed by an MRI of the intracranial vessel wall. Vessel wall imaging has contributed substantially to the diagnosis and follow-up of this case.
Collapse
Affiliation(s)
- Ahmet Kursat Karaman
- Department of Radiology, Sureyyapasa Chest Diseases and Thoracic Surgery Training Hospital, Başıbüyük Mah, Hastane Yolu Cad, Istanbul, 34844, Turkey.
| | - Bora Korkmazer
- Department of Radiology, Division of Neuroradiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Serdar Arslan
- Department of Radiology, Division of Neuroradiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Osman Kızılkılıç
- Department of Radiology, Division of Neuroradiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Naci Koçer
- Department of Radiology, Division of Neuroradiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Civan Islak
- Department of Radiology, Division of Neuroradiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| |
Collapse
|
12
|
Davila-Williams D, Barry M, Vargas C, Vossough A, Bernard TJ, Rafay MF. Cerebral Arteriopathies of Childhood - Current Approaches. Semin Pediatr Neurol 2022; 43:101004. [PMID: 36344018 DOI: 10.1016/j.spen.2022.101004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 09/07/2022] [Accepted: 09/26/2022] [Indexed: 10/14/2022]
Abstract
Up to more than half of previously healthy children presenting with their first arterial ischemic stroke have a cerebral arteriopathy. Cerebral arteriopathies during childhood can be congenital, reflecting abnormal vessel development, or acquired when caused by disruption of vascular homeostasis. Distinguishing different types of cerebral arteriopathies in children can be challenging but of great clinical value as they may dictate different disease and treatment courses, and clinical and radiologic outcomes. Furthermore, children with stroke due to a specific arteriopathy exhibit distinctive features when compared to those with stroke due to other causes or a different type of arteriopathy. These features become crucial in the management of pediatric stroke by choosing appropriate diagnostic and treatment strategies. The objective of this article is to provide the reader with a comprehensive up-to-date review of the classification, symptoms, diagnosis, treatment, and outcome of cerebral arteriopathies in children.
Collapse
Affiliation(s)
| | - Megan Barry
- Section of Neurology, Department of Pediatrics, Hemophilia & Thrombosis Center, University of Colorado, Aurora, Co, USA
| | - Carolina Vargas
- Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Arastoo Vossough
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Timothy J Bernard
- Section of Neurology, Department of Pediatrics, Hemophilia & Thrombosis Center, University of Colorado, Aurora, Co, USA
| | - Mubeen F Rafay
- Children's Hospital Winnipeg, Department of Pediatrics and Child Health, Max Rady College of Medicine, University of Manitoba, Children's Hospital Research Institute of Manitoba, Manitoba, Canada.
| |
Collapse
|
13
|
Acute Hospital Management of Pediatric Stroke. Semin Pediatr Neurol 2022; 43:100990. [PMID: 36344020 DOI: 10.1016/j.spen.2022.100990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 08/13/2022] [Accepted: 08/14/2022] [Indexed: 11/24/2022]
Abstract
The field of pediatric stroke has historically been hampered by limited evidence and small patient cohorts. However the landscape of childhood stroke is rapidly changing due in part to increasing awareness of the importance of pediatric stroke and the emergence of dedicated pediatric stroke centers, care pathways, and alert systems. Acute pediatric stroke management hinges on timely diagnosis confirmed by neuroimaging, appropriate consideration of recanalization therapies, implementation of neuroprotective measures, and attention to secondary prevention. Because pediatric stroke is highly heterogenous in etiology, management strategies must be individualized. Determining a child's underlying stroke etiology is essential to appropriately tailoring hyperacute stroke management and determining best approach to secondary prevention. Herein, we review the methods of recognition, diagnosis, management, current knowledge gaps and promising research for pediatric stroke.
Collapse
|
14
|
Identification of Cervical Artery Dissections: Imaging Strategies and Literature Review. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2022. [DOI: 10.1007/s40138-022-00247-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
15
|
Sporns PB, Fullerton HJ, Lee S, Kim H, Lo WD, Mackay MT, Wildgruber M. Childhood stroke. Nat Rev Dis Primers 2022; 8:12. [PMID: 35210461 DOI: 10.1038/s41572-022-00337-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/07/2022] [Indexed: 01/09/2023]
Abstract
Stroke is an important cause of neurological morbidity in children; most survivors have permanent neurological deficits that affect the remainder of their life. Stroke in childhood, the focus of this Primer, is distinguished from perinatal stroke, defined as stroke before 29 days of age, because of its unique pathogenesis reflecting the maternal-fetal unit. Although approximately 15% of strokes in adults are haemorrhagic, half of incident strokes in children are haemorrhagic and half are ischaemic. The causes of childhood stroke are distinct from those in adults. Urgent brain imaging is essential to confirm the stroke diagnosis and guide decisions about hyperacute therapies. Secondary stroke prevention strongly depends on the underlying aetiology. While the past decade has seen substantial advances in paediatric stroke research, the quality of evidence for interventions, such as the rapid reperfusion therapies that have revolutionized arterial ischaemic stroke care in adults, remains low. Substantial time delays in diagnosis and treatment continue to challenge best possible care. Effective primary stroke prevention strategies in children with sickle cell disease represent a major success, yet barriers to implementation persist. The multidisciplinary members of the International Pediatric Stroke Organization are coordinating global efforts to tackle these challenges and improve the outcomes in children with cerebrovascular disease.
Collapse
Affiliation(s)
- Peter B Sporns
- Department of Neuroradiology, Clinic of Radiology & Nuclear Medicine, University Hospital Basel, Basel, Switzerland.,Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Heather J Fullerton
- Departments of Neurology and Pediatrics, Benioff Children's Hospital, University of California at San Francisco, San Francisco, CA, USA
| | - Sarah Lee
- Division of Child Neurology, Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Helen Kim
- Departments of Anesthesia and Perioperative Care, and Epidemiology and Biostatistics, Center for Cerebrovascular Research, University of California at San Francisco, San Francisco, CA, USA
| | - Warren D Lo
- Departments of Pediatrics and Neurology, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, USA
| | - Mark T Mackay
- Department of Neurology, Royal Children's Hospital, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Moritz Wildgruber
- Department of Radiology, University Hospital Munich, LMU Munich, Munich, Germany.
| |
Collapse
|
16
|
Alotaibi AS, Mahroos RA, Al Yateem SS, Menezes RG. Central Nervous System Causes of Sudden Unexpected Death: A Comprehensive Review. Cureus 2022; 14:e20944. [PMID: 35004089 PMCID: PMC8730823 DOI: 10.7759/cureus.20944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2022] [Indexed: 01/03/2023] Open
|
17
|
Tarsia J, Vidal G, Zweifler RM. Arterial Dissection, Fibromuscular Dysplasia, and Carotid Webs. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00035-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
18
|
Isung J, Isomura K, Larsson H, Sidorchuk A, Fernández de la Cruz L, Mataix-Cols D. Association of Tourette Syndrome and Chronic Tic Disorder With Cervical Spine Disorders and Related Neurological Complications. JAMA Neurol 2021; 78:1205-1211. [PMID: 34424277 DOI: 10.1001/jamaneurol.2021.2798] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Importance Severe forms of Tourette syndrome or chronic tic disorder (TS/CTD) may involve repeated head jerking. Isolated case reports have described a spectrum of severe neck disorders in individuals with TS/CTD. However, the nature and prevalence of cervical spine disorders in TS/CTD are unknown. Objective To establish if TS/CTD are associated with an increased risk of cervical spine disorders and related neurological complications compared with individuals from the general population. Design, Setting, and Participants All individuals born from 1973 to 2013 and living in Sweden between 1997 and 2013 were identified. Individuals with a record of TS/CTD diagnosed in specialist settings were matched on age, sex, and county of birth with 10 unexposed individuals randomly selected from the general population. Cox proportional hazards regression models were used to estimate the risk of vascular and nonvascular cervical spine disorders among exposed individuals, compared with unexposed individuals. Models were adjusted for other known causes of cervical spine injury. Data were analyzed from March 19 to May 16, 2021. Exposures International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnoses of TS/CTD in the Swedish National Patient Register. Main Outcomes and Measures Records of cervical vascular disorders (ie, aneurysm, cerebral infarction, transitory cerebral ischemia) and cervical nonvascular disorders (ie, spondylosis, cervical disc disorders, fractures of the cervical spine, cervicalgia) and cervical surgeries. Covariates included rheumatic disorders, traffic injuries, fall- or sport-related injuries, and attention-deficit/hyperactivity disorder comorbidity. Results A total of 6791 individuals with TS/CTD were identified (5238 [77.1%] were male; median [interquartile] age at first diagnosis, 15.6 [11.4-23.7] years) and matched to 67 910 unexposed individuals. Exposed individuals had a 39% increased risk of any cervical spine disorder (adjusted hazard ratio, 1.39; 95% CI, 1.22-1.59). Adjusted hazard ratios for cervical vascular and nonvascular disorders were 1.57 (95% CI, 1.16-2.13) and 1.38 (95% CI, 1.19-1.60), respectively. Risks were similar among men and women. Conclusions and Relevance Individuals with severe TS/CTD are at increased risk of cervical spine disorders. These outcomes are relatively rare but may lead to persistent disability in some individuals and thus require close monitoring to facilitate early interventions.
Collapse
Affiliation(s)
- Josef Isung
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Kayoko Isomura
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Anna Sidorchuk
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Lorena Fernández de la Cruz
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - David Mataix-Cols
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| |
Collapse
|
19
|
Cerebellar hemorrhage in a newborn: a case report in association with suspected arterial dissection of the posterior inferior cerebellar artery. Childs Nerv Syst 2021; 37:2905-2909. [PMID: 33506303 DOI: 10.1007/s00381-021-05056-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
We herein report a 5-day-old baby boy presented with a massive cerebellar hemorrhage due to suspected posterior inferior cerebellar artery (PICA) dissection. He was born by vacuum extraction at the gestational age of 41 weeks with 3370 g birth weight. On the fifth day of life, he developed dyspnea with worsening vital signs. CT of the head showed massive cerebellar hemorrhage and then transferred to our hospital. External ventricular drainages were emergently placed for his hydrocephalus on the first day of hospitalization, then cerebellar hematoma was evacuated with suboccipital craniotomy on day 11. Under microscopic observation, the left PICA was swollen with dark red discoloration at the caudal loop, being a confirmative finding of arterial dissection. By these findings, we suspected ruptured arterial dissection as a cause of cerebellar hemorrhage. The right PICA looked intact. He required a ventriculoperitoneal shunt on day 59 due to his persistent hydrocephalus, resulting in remarkable improvement of his neurological condition. An MRI, a CT angiography/venography, or blood tests showed no abnormalities such as tumors, vascular anomalies, or coagulopathies. We discuss the significantly rare case of cerebellar hematoma in a newborn, most likely caused by ruptured PICA dissection.
Collapse
|
20
|
Goraya JS, Berry S, Kaur A, Singh G. Arterial Ischemic Stroke-Peculiarities of Clinical Presentation and Risk Factors in Indian Children. Neuropediatrics 2021; 52:294-301. [PMID: 34102685 DOI: 10.1055/s-0041-1728773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
There are not enough recent studies on arterial ischemic stroke (AIS) in Indian children. We retrospectively reviewed data on 95 children (69 boys), aged 3 months to 17 years, with AIS. Focal signs were noted in 84 (88%) with hemiparesis in 72 (76%). Diffuse signs were present in 33 (35%) with fever in 22 (23%), altered mental status in 20 (21%), and headache in 12 (13%). Seizures occurred in 29 (31%) children. Arteriopathy was observed in 57 (60%) children with mineralizing lenticulostriate vasculopathy (mLSV) in 22 (23%) being the most common, followed by moyamoya in 14 (15%), arterial dissection in 9 (10%), and focal cerebral arteriopathy (FCA) in 8 (8%). Preceding head/neck trauma was present in 27 (28%) children: 23 had minor head trauma (MHT), 3 neck trauma, and 1 unspecified. Other common risk factors (RFs) were iron deficiency in 10 children, homocysteinemia in 8 children, and tuberculous meningitis in 5 children. Complete or nearly complete recovery occurred in 42 (44%). Nine children developed epilepsy and five cognitive and language disability. Stroke recurrences occurred in nine children. Overall, arteriopathies accounted for majority of the cases of childhood AIS in our study with mLSV and moyamoya being the most frequent. Compared with data from Western countries, FCAs, postvaricella arteriopathy, and arterial dissections were less common. Of the nonarteriopathic RFs, MHT, iron deficiency, homocysteinemia, and neuroinfections were most frequent in our cohort in contrast to cardioembolic diseases and inherited procoagulant conditions, which are common in developed countries.
Collapse
Affiliation(s)
- Jatinder Singh Goraya
- Division of Pediatric Neurology, Department of Pediatrics, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
| | - Shivankshi Berry
- Division of Pediatric Neurology, Department of Pediatrics, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
| | - Amandeep Kaur
- Division of Pediatric Neurology, Department of Pediatrics, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
| | - Gagandeep Singh
- Division of Pediatric Neurology, Department of Pediatrics, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
| |
Collapse
|
21
|
Cellerini M, Princiotta C, Menozzi R, Capurri G, Russo R, Bergui M. Letter-to-the Editor: Focal cerebral arteriopathy and acute ischaemic stroke in children: A diagnostic-therapeutical conundrum. Eur J Radiol 2021; 142:109846. [PMID: 34247031 DOI: 10.1016/j.ejrad.2021.109846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/29/2021] [Accepted: 07/02/2021] [Indexed: 11/16/2022]
Abstract
Acute ischaemic stroke (AIS) in children is generally considered an up-to-date and controversial topic because its presents significant peculiarities. Focal cerebral arteriopathies (FCA) are a possible cause of AIS in children characterized by an unilateral lesion of the terminal internal cerebral artery (ICA) and proximal segment (M1) of middle cerebral artery (MCA), leading to subocclusion, occasionally with a typical "striate" pattern and a tendency to stability or regression at follow-up. It is unclear whether in FCA the basic lesion is an inflammatory or a dissective arterial pathology. Herein we report a small series of children (<16 yo) with AIS from a FCA who underwent mechanical thrombectomy (MT). We speculate on the angiographic findings suggesting an aetiology of the lesion, and on indications and limits of the currently available treatments.
Collapse
Affiliation(s)
- Martino Cellerini
- Department of Neuroradiology, Bellaria Hospital, IRCCS Istituto delle Scienze Neurologiche di Bologna, Italy.
| | - Ciro Princiotta
- Department of Neuroradiology, Bellaria Hospital, IRCCS Istituto delle Scienze Neurologiche di Bologna, Italy
| | | | | | - Riccardo Russo
- Department of Neuroradiology, Città della Salute University Hospital, Torino, Italy
| | - Mauro Bergui
- Department of Neuroradiology, Città della Salute University Hospital, Torino, Italy
| |
Collapse
|
22
|
Pizzatto R, Resende LL, Lobo CFT, Neves YCS, Paz JAD, Alves CAPF, Leite CDC, Lucato LT. Arteriopathy in pediatric stroke: an underestimated clinical entity. ARQUIVOS DE NEURO-PSIQUIATRIA 2021; 79:321-333. [PMID: 34133513 DOI: 10.1590/0004-282x-anp-2020-0105] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 08/07/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Pediatric arterial ischemic stroke (AIS), which was thought to be a rare disorder, is being increasingly recognized as an important cause of neurological morbidity, thanks to new advances in neuroimaging. OBJECTIVE The aim of this study was to review the main etiologies of stroke due to arteriopathy in children. METHODS Using a series of cases from our institution, we addressed its epidemiological aspects, physiopathology, imaging findings from CT, MR angiography, MR conventional sequences and MR DWI, and nuclear medicine findings. RESULTS Through discussion of the most recent classification for childhood AIS (Childhood AIS Standardized Classification and Diagnostic Evaluation, CASCADE), we propose a modified classification based on the anatomical site of disease, which includes vasculitis, varicella, arterial dissection, moyamoya, fibromuscular dysplasia, Takayasu's arteritis and genetic causes (such as ACTA-2 mutation, PHACE syndrome and ADA-2 deficiency). We have detailed each of these separately. Conclusions: Prompt recognition of AIS and thorough investigation for potential risk factors are crucial for a better outcome. In this scenario, neurovascular imaging plays an important role in diagnosing AIS and identifying children at high risk of recurrent stroke.
Collapse
Affiliation(s)
- Ronaldo Pizzatto
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto de Radiologia, São Paulo SP, Brazil
| | - Lucas Lopes Resende
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto de Radiologia, São Paulo SP, Brazil
| | - Carlos Felipe Teixeira Lobo
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto de Radiologia, São Paulo SP, Brazil
| | - Yuri Costa Sarno Neves
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto de Radiologia, São Paulo SP, Brazil
| | - José Albino da Paz
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto de Pediatria, São Paulo SP, Brazil
| | | | - Claudia da Costa Leite
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto de Radiologia, São Paulo SP, Brazil
| | - Leandro Tavares Lucato
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto de Radiologia, São Paulo SP, Brazil
| |
Collapse
|
23
|
Hypoxic-ischemic injury causes functional and structural neurovascular degeneration in the juvenile mouse retina. Sci Rep 2021; 11:12670. [PMID: 34135369 PMCID: PMC8209038 DOI: 10.1038/s41598-021-90447-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 05/04/2021] [Indexed: 12/11/2022] Open
Abstract
Ischemic stroke is a major cause of long-term disabilities, including vision loss. Neuronal and blood vessel maturation can affect the susceptibility of and outcome after ischemic stroke. Although we recently reported that exposure of neonatal mice to hypoxia–ischemia (HI) severely compromises the integrity of the retinal neurovasculature, it is not known whether juvenile mice are similarly impacted. Here we examined the effect of HI injury in juvenile mice on retinal structure and function, in particular the susceptibility of retinal neurons and blood vessels to HI damage. Our studies demonstrated that the retina suffered from functional and structural injuries, including reduced b-wave, thinning of the inner retinal layers, macroglial remodeling, and deterioration of the vasculature. The degeneration of the retinal vasculature associated with HI resulted in a significant decrease in the numbers of pericytes and endothelial cells as well as an increase in capillary loss. Taken together, these findings suggest a need for juveniles suffering from ischemic stroke to be monitored for changes in retinal functional and structural integrity. Thus, there is an emergent need for developing therapeutic approaches to prevent and reverse retinal neurovascular dysfunction with exposure to ischemic stroke.
Collapse
|
24
|
Jay CRG, Duncan AN, Ellika SK, Bender MT. Stents for progressively symptomatic paediatric intracranial arterial dissection. BMJ Case Rep 2021; 14:14/5/e017464. [PMID: 34059529 DOI: 10.1136/bcr-2021-017464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Arterial dissection is an uncommon cause of paediatric stroke. Medical therapy remains first-line for treatment. There are few reports of neurovascular stents for paediatric intracranial arterial dissection. Two adolescents presented with neurological deficits and CT angiography concerning for supraclinoid internal carotid artery stenosis. The diagnosis of dissection was secured through a combination of vessel wall MRI and digital subtraction angiography. The patients experienced progressive ischaemic symptoms, despite medical management including anticoagulation, and required stenting. The stents used were a Neuroform EZ and an Atlas. Both patients recovered to Modified Rankin Scale (mRS) 0 and had restored vessel calibre on 6-month follow-up digital subtraction angiography. Neurovascular stents can be used to treat progressively symptomatic intracranial arterial dissections in the paediatric population if medical therapy fails.
Collapse
Affiliation(s)
- Catherine R G Jay
- Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Aubrey N Duncan
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - Shehanaz K Ellika
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York, USA
| | - Matthew T Bender
- Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA
| |
Collapse
|
25
|
Al-Banaa K, Alshaikhli A, Al-Hareeri A, Abdelhalim M, Al-Hillan A, Joshi T. Arterial Dissection in Antiphospholipid Syndrome Patients: Two Case Reports and a Literature Review. Eur J Case Rep Intern Med 2021; 8:002610. [PMID: 34123952 DOI: 10.12890/2021_002610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 05/07/2021] [Indexed: 11/05/2022] Open
Abstract
Antiphospholipid syndrome (APS) is a multisystemic autoimmune disease which presents with thromboembolic disease, pregnancy complications and the presence of antiphospholipid antibodies. There are some reports of arterial dissections in different sites of the body associated with APS. We describe two patients with APS who developed ischaemic stroke as a result of vertebral artery dissection in the absence of acquired and genetic risk factors for arterial dissection. We also conducted a systematic review of the literature for cases of arterial dissection associated with APS. We suspect that APS may be a potential cause of vasculopathy and arterial dissection. Further research is needed to explore this possible association. LEARNING POINTS Antiphospholipid syndrome (APS) is a major risk factor for stroke in young patients.APS may be associated with vasculopathy and arterial dissection.Patients should meet both clinical and laboratory criteria for a diagnosis of APS.
Collapse
Affiliation(s)
- Kadhim Al-Banaa
- Department of Haemostasis and Thrombosis, University of California San Diego Health, San Diego, CA, USA
| | - Alfarooq Alshaikhli
- Department of Medicine, University of Texas/Rio Grande Valley, Edinburg, TX, USA
| | - Asal Al-Hareeri
- Department of Surgery, Harborview Medical Center, Seattle, WA, USA
| | | | - Alsadiq Al-Hillan
- Department of Gastroenterology, Beaumont Hospital, Royal Oak, MI, USA
| | - Tejas Joshi
- Department Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA
| |
Collapse
|
26
|
Bond KM, Krings T, Lanzino G, Brinjikji W. Intracranial dissections: A pictorial review of pathophysiology, imaging features, and natural history. J Neuroradiol 2021; 48:176-188. [DOI: 10.1016/j.neurad.2020.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/30/2020] [Accepted: 03/30/2020] [Indexed: 01/22/2023]
|
27
|
Bhatia V, Saini A, Chauhan R. Spontaneous thrombosis and stabilization of a dissecting PCA aneurysm in a child. J Pediatr Neurosci 2021; 16:341-343. [DOI: 10.4103/jpn.jpn_234_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/22/2020] [Accepted: 11/22/2020] [Indexed: 11/07/2022] Open
|
28
|
Spontaneous intracranial internal carotid artery dissection in an adolescent after heavy exercise. Childs Nerv Syst 2021; 37:2959-2961. [PMID: 34420065 PMCID: PMC8380107 DOI: 10.1007/s00381-021-05334-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 12/02/2022]
|
29
|
Predisposing factors and radiological features in patients with internal carotid artery dissection or vertebral artery dissection. BMC Neurol 2020; 20:445. [PMID: 33302898 PMCID: PMC7731460 DOI: 10.1186/s12883-020-02020-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 12/02/2020] [Indexed: 02/07/2023] Open
Abstract
Background Cervicocerebral artery dissection is an important cause of ischemic stroke in young and middle-aged individuals. However, very few studies have compared the differential features between internal carotid artery dissection (ICAD) and vertebral artery dissection (VAD), including both cervical and intracranial artery dissections. We conducted a study to investigate the predisposing factors and radiological features in patients with ICAD or VAD. Methods All cases diagnosed with cervicocerebral artery dissection, ICAD, or VAD were identified through a medical records database, between January 2010 and January 2020. Baseline characteristics, predisposing factors, and radiological features of ICAD versus VAD were compared. Results A total of 140 patients with cervicocerebral artery dissection were included in the study, including 84 patients in the ICAD group and 56 in the VAD group. The mean age of patients in the ICAD and VAD groups was 43.37 ± 14.01 and 41.00 ± 12.98 years old, respectively. Patients with ICAD were more likely to be men compared with VAD (85.71% vs. 67.86%, p = 0.012). The frequency of hypertension, diabetes, smoking, drinking, and cervical trauma did not differ between ICAD and VAD. Dissections of ICAD were more frequently at the extracranial portions of the artery compared with those of VAD (70.24% vs. 44.64%, p = 0.003). In contrast, dissections of VAD were more common in the intracranial artery (55.36% vs. 29.76%, p = 0.003). Radiologically, double lumen (36.90% vs. 19.64%, p = 0.029) and intimal flap (11.90% vs. 1.79%, p = 0.029) were more frequently observed in ICAD than in VAD, and dissecting aneurysms were less frequent (13.10% vs. 26.79%, p = 0.041). Conclusions The distributions of cervical and intracranial artery dissections were different between ICAD and VAD. The frequencies of radiological features detected in patients with ICAD and VAD also differed.
Collapse
|
30
|
Jabeen S, Pendharkar HS, Prasad C, Hr A, Saini J, Gupta AK, Shukla D. Dissecting aneurysms of the posterior cerebral artery - A retrospective review of imaging, angiographic characteristics, endovascular management and outcome. Interv Neuroradiol 2020; 27:152-162. [PMID: 33115298 DOI: 10.1177/1591019920967572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To review management, clinical and imaging outcomes of dissecting posterior cerebral artery (PCA) aneurysms with emphasis on endovascular management in the form of parent vessel occlusion (PVO) at a tertiary care center. METHODS Thirty-six dissecting PCA aneurysms (19 ruptured) encountered at our center between January 2013 and November 2019 were reviewed for aneurysm location/size/presence of fetal PCA/management. Postprocedural imaging of patients who underwent endovascular intervention was reviewed for PCA territory infarcts and clinical records assessed for presence of neuro-deficits and outcome. None of the patients underwent a balloon test occlusion (BTO) prior to PVO. RESULTS The location of the aneurysms was as follows-P1 = 8/P1-P2 = 11/P2 = 5/P2-P3 = 10/P3 = 2. The mean size was 11.7x6.8 mm. Endovascular intervention was carried out in 20 patients in the form of PVO with coiling in 16 patients, coiling alone in 3 patients, and reconstruction of the left PCA with flow diverter deployment in one patient. Postprocedural PCA territory infarct was seen in 5 cases of PVO out of which 4 had a good functional recovery. Overall, 15/16 patients (93.7%) who underwent PVO had mRS ≤ 2 on follow-up. The single case with flow diverter also developed an infarct and had adverse outcome on follow up. CONCLUSION Among the various management strategies for dissecting PCA aneurysms, PVO is feasible and relatively safe even in absence of BTO in scenarios like critically ill patients with ruptured aneurysms, difficult access and financial constraints. Thromboembolic complications and antiplatelet therapy is a concern in reconstructive strategies.
Collapse
Affiliation(s)
- Shumyla Jabeen
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Hima S Pendharkar
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Chandrajit Prasad
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Arvinda Hr
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Jitender Saini
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Arun Kumar Gupta
- Department of Vascular and Interventional Radiology, Paras Hospital, Gurgaon, India
| | - Dhaval Shukla
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, India
| |
Collapse
|
31
|
Cerebrovascular Complications of Pediatric Blunt Trauma. Pediatr Neurol 2020; 108:5-12. [PMID: 32111560 PMCID: PMC7306436 DOI: 10.1016/j.pediatrneurol.2019.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 12/02/2019] [Accepted: 12/08/2019] [Indexed: 12/13/2022]
Abstract
Ischemic and hemorrhagic stroke can occur in the setting of pediatric trauma, particularly those with head or neck injuries. The risk of stroke appears highest within the first two weeks after trauma. Stroke diagnosis may be challenging due to lack of awareness or concurrent injuries limiting detailed neurological assessment. Other injuries may also complicate stroke management, with competing priorities for blood pressure, ventilator management, or antithrombotic timing. Here we review epidemiology, clinical presentation, and diagnostic approach to blunt arterial injuries including dissection, cerebral sinovenous thrombosis, mineralizing angiopathy, stroke from abusive head trauma, and traumatic hemorrhagic stroke. Owing to the complexities and heterogeneity of concomitant injuries in stroke related to trauma, a single pathway for stroke management is impractical. Therefore providers must understand the goals and possible costs or consequences of stroke management decisions to individualize patient care. We discuss the physiological principles of cerebral perfusion and oxygen delivery, considerations for ventilator strategy when stroke and lung injury are present, and current available evidence of the risks and benefits of anticoagulation to provide a framework for multidisciplinary discussions of cerebrovascular injury management in pediatric patients with trauma.
Collapse
|
32
|
Rafay MF, Shapiro KA, Surmava AM, deVeber GA, Kirton A, Fullerton HJ, Amlie-Lefond C, Weschke B, Dlamini N, Carpenter JL, Mackay MT, Rivkin M, Linds A, Bernard TJ. Spectrum of cerebral arteriopathies in children with arterial ischemic stroke. Neurology 2020; 94:e2479-e2490. [PMID: 32457211 DOI: 10.1212/wnl.0000000000009557] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 11/25/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine that children with arterial ischemic stroke (AIS) due to an identifiable arteriopathy are distinct from those without arteriopathy and that each arteriopathy subtype has unique and recognizable clinical features. METHODS We report a large, observational, multicenter cohort of children with AIS, age 1 month to 18 years, enrolled in the International Pediatric Stroke Study from 2003 to 2014. Clinical and demographic differences were compared by use of the Fisher exact test, with linear step-up permutation min-p adjustment for multiple comparisons. Exploratory analyses were conducted to evaluate differences between cases of AIS with and without arteriopathy and between arteriopathy subtypes. RESULTS Of 2,127 children with AIS, 725 (34%) had arteriopathy (median age 7.45 years). Arteriopathy subtypes included dissection (27%), moyamoya (24.5%), focal cerebral arteriopathy-inflammatory subtype (FCA-i; 15%), diffuse cerebral vasculitis (15%), and nonspecific arteriopathy (18.5%). Children with arteriopathic AIS were more likely to present between 6 and 9 years of age (odds ratio [OR] 1.93, p = 0.029) with headache (OR 1.55, p = 0.023), multiple infarctions (OR 2.05, p < 0.001), sickle cell anemia (OR 2.9, p = 0.007), and head/neck trauma (OR 1.93, p = 0.018). Antithrombotic use and stroke recurrence were higher in children with arteriopathy. Among arteriopathy subtypes, dissection was associated with male sex, older age, headache, and anticoagulant use; FCA-i was associated with hemiparesis and single infarcts; moyamoya was associated with seizures and recurrent strokes; and vasculitis was associated with bilateral infarctions. CONCLUSION Specific clinical profiles are associated with cerebral arteriopathies in children with AIS. These observations may be helpful indicators in guiding early diagnosis and defining subgroups who may benefit most from future therapeutic trials.
Collapse
Affiliation(s)
- Mubeen F Rafay
- From the Section of Pediatric Neurology (M.F.R.), Department of Pediatrics and Child Health, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Canada; Department of Neurology and Pediatrics (K.A.S., H.J.F.), University of California, San Francisco; University of Toronto (A.-M.S.); Division of Neurology (G.A.d.V., N.D., A.L.), The Hospital for Sick Children, University of Toronto, Ontario; Department of Pediatrics and Clinical Neurosciences (A.K.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Neurology (C.A.-L.), University of Washington, Seattle; Department of Neuropediatrics (B.W.), Charité University Medicine Berlin, Germany; Department of Neurology (J.L.C.), George Washington University, Washington, DC; Department of Neurology (M.T.M.), Royal Children's Hospital Melbourne, Murdoch Children's Research Institute and University of Melbourne, Australia; Boston Children's Hospital (M.R.), Harvard Medical School, Boston, MA; and Division of Child Neurology (T.J.B.), Department of Pediatrics and the Hemophilia and Thrombosis Center, University of Colorado, Denver.
| | - Kevin A Shapiro
- From the Section of Pediatric Neurology (M.F.R.), Department of Pediatrics and Child Health, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Canada; Department of Neurology and Pediatrics (K.A.S., H.J.F.), University of California, San Francisco; University of Toronto (A.-M.S.); Division of Neurology (G.A.d.V., N.D., A.L.), The Hospital for Sick Children, University of Toronto, Ontario; Department of Pediatrics and Clinical Neurosciences (A.K.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Neurology (C.A.-L.), University of Washington, Seattle; Department of Neuropediatrics (B.W.), Charité University Medicine Berlin, Germany; Department of Neurology (J.L.C.), George Washington University, Washington, DC; Department of Neurology (M.T.M.), Royal Children's Hospital Melbourne, Murdoch Children's Research Institute and University of Melbourne, Australia; Boston Children's Hospital (M.R.), Harvard Medical School, Boston, MA; and Division of Child Neurology (T.J.B.), Department of Pediatrics and the Hemophilia and Thrombosis Center, University of Colorado, Denver
| | - Ann-Marie Surmava
- From the Section of Pediatric Neurology (M.F.R.), Department of Pediatrics and Child Health, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Canada; Department of Neurology and Pediatrics (K.A.S., H.J.F.), University of California, San Francisco; University of Toronto (A.-M.S.); Division of Neurology (G.A.d.V., N.D., A.L.), The Hospital for Sick Children, University of Toronto, Ontario; Department of Pediatrics and Clinical Neurosciences (A.K.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Neurology (C.A.-L.), University of Washington, Seattle; Department of Neuropediatrics (B.W.), Charité University Medicine Berlin, Germany; Department of Neurology (J.L.C.), George Washington University, Washington, DC; Department of Neurology (M.T.M.), Royal Children's Hospital Melbourne, Murdoch Children's Research Institute and University of Melbourne, Australia; Boston Children's Hospital (M.R.), Harvard Medical School, Boston, MA; and Division of Child Neurology (T.J.B.), Department of Pediatrics and the Hemophilia and Thrombosis Center, University of Colorado, Denver
| | - Gabrielle A deVeber
- From the Section of Pediatric Neurology (M.F.R.), Department of Pediatrics and Child Health, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Canada; Department of Neurology and Pediatrics (K.A.S., H.J.F.), University of California, San Francisco; University of Toronto (A.-M.S.); Division of Neurology (G.A.d.V., N.D., A.L.), The Hospital for Sick Children, University of Toronto, Ontario; Department of Pediatrics and Clinical Neurosciences (A.K.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Neurology (C.A.-L.), University of Washington, Seattle; Department of Neuropediatrics (B.W.), Charité University Medicine Berlin, Germany; Department of Neurology (J.L.C.), George Washington University, Washington, DC; Department of Neurology (M.T.M.), Royal Children's Hospital Melbourne, Murdoch Children's Research Institute and University of Melbourne, Australia; Boston Children's Hospital (M.R.), Harvard Medical School, Boston, MA; and Division of Child Neurology (T.J.B.), Department of Pediatrics and the Hemophilia and Thrombosis Center, University of Colorado, Denver
| | - Adam Kirton
- From the Section of Pediatric Neurology (M.F.R.), Department of Pediatrics and Child Health, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Canada; Department of Neurology and Pediatrics (K.A.S., H.J.F.), University of California, San Francisco; University of Toronto (A.-M.S.); Division of Neurology (G.A.d.V., N.D., A.L.), The Hospital for Sick Children, University of Toronto, Ontario; Department of Pediatrics and Clinical Neurosciences (A.K.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Neurology (C.A.-L.), University of Washington, Seattle; Department of Neuropediatrics (B.W.), Charité University Medicine Berlin, Germany; Department of Neurology (J.L.C.), George Washington University, Washington, DC; Department of Neurology (M.T.M.), Royal Children's Hospital Melbourne, Murdoch Children's Research Institute and University of Melbourne, Australia; Boston Children's Hospital (M.R.), Harvard Medical School, Boston, MA; and Division of Child Neurology (T.J.B.), Department of Pediatrics and the Hemophilia and Thrombosis Center, University of Colorado, Denver
| | - Heather J Fullerton
- From the Section of Pediatric Neurology (M.F.R.), Department of Pediatrics and Child Health, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Canada; Department of Neurology and Pediatrics (K.A.S., H.J.F.), University of California, San Francisco; University of Toronto (A.-M.S.); Division of Neurology (G.A.d.V., N.D., A.L.), The Hospital for Sick Children, University of Toronto, Ontario; Department of Pediatrics and Clinical Neurosciences (A.K.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Neurology (C.A.-L.), University of Washington, Seattle; Department of Neuropediatrics (B.W.), Charité University Medicine Berlin, Germany; Department of Neurology (J.L.C.), George Washington University, Washington, DC; Department of Neurology (M.T.M.), Royal Children's Hospital Melbourne, Murdoch Children's Research Institute and University of Melbourne, Australia; Boston Children's Hospital (M.R.), Harvard Medical School, Boston, MA; and Division of Child Neurology (T.J.B.), Department of Pediatrics and the Hemophilia and Thrombosis Center, University of Colorado, Denver
| | - Catherine Amlie-Lefond
- From the Section of Pediatric Neurology (M.F.R.), Department of Pediatrics and Child Health, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Canada; Department of Neurology and Pediatrics (K.A.S., H.J.F.), University of California, San Francisco; University of Toronto (A.-M.S.); Division of Neurology (G.A.d.V., N.D., A.L.), The Hospital for Sick Children, University of Toronto, Ontario; Department of Pediatrics and Clinical Neurosciences (A.K.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Neurology (C.A.-L.), University of Washington, Seattle; Department of Neuropediatrics (B.W.), Charité University Medicine Berlin, Germany; Department of Neurology (J.L.C.), George Washington University, Washington, DC; Department of Neurology (M.T.M.), Royal Children's Hospital Melbourne, Murdoch Children's Research Institute and University of Melbourne, Australia; Boston Children's Hospital (M.R.), Harvard Medical School, Boston, MA; and Division of Child Neurology (T.J.B.), Department of Pediatrics and the Hemophilia and Thrombosis Center, University of Colorado, Denver
| | - Bernhard Weschke
- From the Section of Pediatric Neurology (M.F.R.), Department of Pediatrics and Child Health, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Canada; Department of Neurology and Pediatrics (K.A.S., H.J.F.), University of California, San Francisco; University of Toronto (A.-M.S.); Division of Neurology (G.A.d.V., N.D., A.L.), The Hospital for Sick Children, University of Toronto, Ontario; Department of Pediatrics and Clinical Neurosciences (A.K.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Neurology (C.A.-L.), University of Washington, Seattle; Department of Neuropediatrics (B.W.), Charité University Medicine Berlin, Germany; Department of Neurology (J.L.C.), George Washington University, Washington, DC; Department of Neurology (M.T.M.), Royal Children's Hospital Melbourne, Murdoch Children's Research Institute and University of Melbourne, Australia; Boston Children's Hospital (M.R.), Harvard Medical School, Boston, MA; and Division of Child Neurology (T.J.B.), Department of Pediatrics and the Hemophilia and Thrombosis Center, University of Colorado, Denver
| | - Nomazulu Dlamini
- From the Section of Pediatric Neurology (M.F.R.), Department of Pediatrics and Child Health, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Canada; Department of Neurology and Pediatrics (K.A.S., H.J.F.), University of California, San Francisco; University of Toronto (A.-M.S.); Division of Neurology (G.A.d.V., N.D., A.L.), The Hospital for Sick Children, University of Toronto, Ontario; Department of Pediatrics and Clinical Neurosciences (A.K.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Neurology (C.A.-L.), University of Washington, Seattle; Department of Neuropediatrics (B.W.), Charité University Medicine Berlin, Germany; Department of Neurology (J.L.C.), George Washington University, Washington, DC; Department of Neurology (M.T.M.), Royal Children's Hospital Melbourne, Murdoch Children's Research Institute and University of Melbourne, Australia; Boston Children's Hospital (M.R.), Harvard Medical School, Boston, MA; and Division of Child Neurology (T.J.B.), Department of Pediatrics and the Hemophilia and Thrombosis Center, University of Colorado, Denver
| | - Jessica L Carpenter
- From the Section of Pediatric Neurology (M.F.R.), Department of Pediatrics and Child Health, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Canada; Department of Neurology and Pediatrics (K.A.S., H.J.F.), University of California, San Francisco; University of Toronto (A.-M.S.); Division of Neurology (G.A.d.V., N.D., A.L.), The Hospital for Sick Children, University of Toronto, Ontario; Department of Pediatrics and Clinical Neurosciences (A.K.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Neurology (C.A.-L.), University of Washington, Seattle; Department of Neuropediatrics (B.W.), Charité University Medicine Berlin, Germany; Department of Neurology (J.L.C.), George Washington University, Washington, DC; Department of Neurology (M.T.M.), Royal Children's Hospital Melbourne, Murdoch Children's Research Institute and University of Melbourne, Australia; Boston Children's Hospital (M.R.), Harvard Medical School, Boston, MA; and Division of Child Neurology (T.J.B.), Department of Pediatrics and the Hemophilia and Thrombosis Center, University of Colorado, Denver
| | - Mark T Mackay
- From the Section of Pediatric Neurology (M.F.R.), Department of Pediatrics and Child Health, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Canada; Department of Neurology and Pediatrics (K.A.S., H.J.F.), University of California, San Francisco; University of Toronto (A.-M.S.); Division of Neurology (G.A.d.V., N.D., A.L.), The Hospital for Sick Children, University of Toronto, Ontario; Department of Pediatrics and Clinical Neurosciences (A.K.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Neurology (C.A.-L.), University of Washington, Seattle; Department of Neuropediatrics (B.W.), Charité University Medicine Berlin, Germany; Department of Neurology (J.L.C.), George Washington University, Washington, DC; Department of Neurology (M.T.M.), Royal Children's Hospital Melbourne, Murdoch Children's Research Institute and University of Melbourne, Australia; Boston Children's Hospital (M.R.), Harvard Medical School, Boston, MA; and Division of Child Neurology (T.J.B.), Department of Pediatrics and the Hemophilia and Thrombosis Center, University of Colorado, Denver
| | - Michael Rivkin
- From the Section of Pediatric Neurology (M.F.R.), Department of Pediatrics and Child Health, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Canada; Department of Neurology and Pediatrics (K.A.S., H.J.F.), University of California, San Francisco; University of Toronto (A.-M.S.); Division of Neurology (G.A.d.V., N.D., A.L.), The Hospital for Sick Children, University of Toronto, Ontario; Department of Pediatrics and Clinical Neurosciences (A.K.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Neurology (C.A.-L.), University of Washington, Seattle; Department of Neuropediatrics (B.W.), Charité University Medicine Berlin, Germany; Department of Neurology (J.L.C.), George Washington University, Washington, DC; Department of Neurology (M.T.M.), Royal Children's Hospital Melbourne, Murdoch Children's Research Institute and University of Melbourne, Australia; Boston Children's Hospital (M.R.), Harvard Medical School, Boston, MA; and Division of Child Neurology (T.J.B.), Department of Pediatrics and the Hemophilia and Thrombosis Center, University of Colorado, Denver
| | - Alexandra Linds
- From the Section of Pediatric Neurology (M.F.R.), Department of Pediatrics and Child Health, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Canada; Department of Neurology and Pediatrics (K.A.S., H.J.F.), University of California, San Francisco; University of Toronto (A.-M.S.); Division of Neurology (G.A.d.V., N.D., A.L.), The Hospital for Sick Children, University of Toronto, Ontario; Department of Pediatrics and Clinical Neurosciences (A.K.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Neurology (C.A.-L.), University of Washington, Seattle; Department of Neuropediatrics (B.W.), Charité University Medicine Berlin, Germany; Department of Neurology (J.L.C.), George Washington University, Washington, DC; Department of Neurology (M.T.M.), Royal Children's Hospital Melbourne, Murdoch Children's Research Institute and University of Melbourne, Australia; Boston Children's Hospital (M.R.), Harvard Medical School, Boston, MA; and Division of Child Neurology (T.J.B.), Department of Pediatrics and the Hemophilia and Thrombosis Center, University of Colorado, Denver
| | - Timothy J Bernard
- From the Section of Pediatric Neurology (M.F.R.), Department of Pediatrics and Child Health, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Canada; Department of Neurology and Pediatrics (K.A.S., H.J.F.), University of California, San Francisco; University of Toronto (A.-M.S.); Division of Neurology (G.A.d.V., N.D., A.L.), The Hospital for Sick Children, University of Toronto, Ontario; Department of Pediatrics and Clinical Neurosciences (A.K.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Neurology (C.A.-L.), University of Washington, Seattle; Department of Neuropediatrics (B.W.), Charité University Medicine Berlin, Germany; Department of Neurology (J.L.C.), George Washington University, Washington, DC; Department of Neurology (M.T.M.), Royal Children's Hospital Melbourne, Murdoch Children's Research Institute and University of Melbourne, Australia; Boston Children's Hospital (M.R.), Harvard Medical School, Boston, MA; and Division of Child Neurology (T.J.B.), Department of Pediatrics and the Hemophilia and Thrombosis Center, University of Colorado, Denver
| | | |
Collapse
|
33
|
Hejrati N, Ebel F, Guzman R, Soleman J. Posttraumatic cerebrovascular injuries in children. A systematic review. Childs Nerv Syst 2020; 36:251-262. [PMID: 31901968 DOI: 10.1007/s00381-019-04482-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 12/17/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Posttraumatic craniocervical vascular injuries in pediatric traumatic brain injury (TBI) are rare, and children-specific, evidence-based standards on screening and therapy of posttraumatic carotid-cavernous fistula (CCF), craniocervical artery dissections (CCAD), traumatic aneurysms (TA), and posttraumatic sinus venous thrombosis (SVT) is lacking. The aim of this review is to summarize the data on epidemiology, clinical presentation, and treatment of these traumatic lesions in a systematic manner. METHODS We performed a systematic PubMed search for records of CCF, CCAD, TA, and SVT related to pediatric TBI published until June 2019. RESULTS After screening 2439 records, 42 were included in the quantitative analysis. Incidences for CCAD in blunt TBI were 0.21% (range 0.02-6.82%). 11.7% (range 1.69-15.58%) of pediatric aneurysms were found to be traumatic of origin, whereas 38.2% (range 36.84-40%) of all pediatric SVT were due to blunt TBI. For all of the posttraumatic cerebrovascular pathologies, we found a clear male predominance with 68.75% in CCF, 63.4% in CCAD, 60% in TA, and 58.33% in SVT. Clinical presentation did not differ from the adult population with exception of young child. While there is only recommendation for the therapy of CCAD and SVT in the pediatric population, no such recommendation exists for the treatment of CCF's and TA's, and data from randomized controlled trials is lacking. CONCLUSION While these results show that posttraumatic CCF, CCAD, TA, and SVT are rarely encountered in children, misdiagnosis may have potentially drastic consequences due to a longer lifetime burden in the pediatric population. Awareness, early recognition, and prompt initiation of the appropriate therapy are essential to avoid morbidity and mortality. Further studies should focus on the development of clinical and radiological screening criteria of posttraumatic vascular lesions in children.
Collapse
Affiliation(s)
- Nader Hejrati
- Department of Neurosurgery, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
| | - Florian Ebel
- Department of Neurosurgery, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland
| | - Raphael Guzman
- Department of Neurosurgery, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland.,Division of Pediatric Neurosurgery, University Children's Hospital of Basel, Spitalstrasse 33, Basel, 4056, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Jehuda Soleman
- Department of Neurosurgery, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland.,Division of Pediatric Neurosurgery, University Children's Hospital of Basel, Spitalstrasse 33, Basel, 4056, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland
| |
Collapse
|
34
|
|
35
|
Gilardone G, Fumagalli FM, Monti A, Pintavalle G, Troletti ID, Gilardone M, Corbo M. Multidisciplinary rehabilitation of a post-stroke pediatric patient considering the ICF perspective. J Pediatr Rehabil Med 2020; 13:255-262. [PMID: 32716333 DOI: 10.3233/prm-190636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE There is a general lack of evidence on the efficacy of rehabilitation training methods after childhood stroke. The aim of the current paper is to provide an example of a multidisciplinary assessment and intensive patient-centered rehabilitation program that was devised following the Clinical Guidelines for Childhood Stroke Diagnosis, Management and Rehabilitation, based on the International Classification of Functioning, Disability and Health. METHOD The case of a 13-year-old teenager with physical, linguistic, cognitive and emotional impairments after acute ischemic stroke (AIS) in left middle cerebral artery territories is presented and his neurorehabilitation program is described. RESULTS After an intensive and comprehensive rehabilitation period, the patient showed significant improvement involving language abilities, cognitive flexibility, logical reasoning and motor independence. A 6-month post-stroke follow-up evaluation showed further gains in spontaneous language, improved motivation and collaboration, reduction of impulsiveness and better general motor stability. CONCLUSION This case highlights how an intensive, patient-centered, interdisciplinary rehabilitation approach can lead to good improvement across different domains, maximizing the spontaneous recovery in children and adolescents after AIS.
Collapse
|
36
|
Goeggel Simonetti B, Rafay MF, Chung M, Lo WD, Beslow LA, Billinghurst LL, Fox CK, Pagnamenta A, Steinlin M, Mackay MT. Comparative study of posterior and anterior circulation stroke in childhood: Results from the International Pediatric Stroke Study. Neurology 2019; 94:e337-e344. [PMID: 31857436 DOI: 10.1212/wnl.0000000000008837] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 08/07/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare risk factors, clinical presentation, and outcomes after posterior circulation arterial ischemic stroke (PCAIS) and anterior circulation arterial ischemic stroke (ACAIS) in neonates and children. METHODS In this international multicenter observational study including neonates and children up to 18 years of age with arterial ischemic stroke (AIS), we compared clinical and radiologic features according to stroke location. RESULTS Of 2,768 AIS cases, 507 (18%) were located in the posterior circulation, 1,931 (70%) in the anterior circulation, and 330 (12%) involved both. PCAIS was less frequent in neonates compared to children (8.8% vs 22%, p < 0.001). Children with PCAIS were older than children with ACAIS (median age 7.8 [interquartile range (IQR) 3.1-14] vs 5.1 [IQR 1.5-12] years, p < 0.001), and more often presented with headache (54% vs 32%, p < 0.001) and a lower Pediatric NIH Stroke Scale score (4 [IQR 2-8] vs 8 [IQR 3-13], p = 0.001). Cervicocephalic artery dissections (CCAD) were more frequent (20% vs 8.5%, p < 0.001), while cardioembolic strokes were less frequent (19% vs 32%, p < 0.001) in PCAIS. Case fatality rates were equal in both groups (2.9%). PCAIS survivors had a better outcome (normal neurologic examination at hospital discharge in 29% vs 21%, p = 0.002) than ACAIS survivors, although this trend was only observed in children and not in neonates. CONCLUSION PCAIS is less common than ACAIS in both neonates and children. Children with PCAIS are older and have a higher rate of CCAD, lower clinical stroke severity, and better outcome than children with ACAIS.
Collapse
Affiliation(s)
- Barbara Goeggel Simonetti
- From the Neurovascular Research Group, Department of Neurology (B.G.S.), and Division of Child Neurology, Department of Pediatrics (B.G.S., M.S.), Inselspital Bern, University Hospital, University of Bern; Pediatric Neurology (B.G.S.), Institute of Pediatrics of Southern Switzerland, San Giovanni Hospital Bellinzona, Ente Ospedaliero Cantonale, Switzerland; Section of Pediatric Neurology, Department of Pediatrics and Child Health (M.F.R.), University of Manitoba, Children's Hospital Research Institute of Manitoba, Canada; Division of Neurology, Department of Pediatrics (M.C., W.D.L.), The Ohio State University and Nationwide Children's Hospital, Columbus; Division of Neurology (L.A.B., L.L.B.), Children's Hospital of Philadelphia; Departments of Neurology and Pediatrics (L.A.B., L.L.B.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Departments of Neurology and Pediatrics (C.K.F.), University of California, San Francisco; Unit of Clinical Epidemiology (A.P.), Ente Ospedaliero Cantonale, Bellinzona; Division of Pneumology (A.P.), University of Geneva, Switzerland; and Department of Neurology (M.T.M.), Royal Children's Hospital Melbourne, Murdoch Children's Research Institute Melbourne, Parkville, Victoria, Australia.
| | - Mubeen F Rafay
- From the Neurovascular Research Group, Department of Neurology (B.G.S.), and Division of Child Neurology, Department of Pediatrics (B.G.S., M.S.), Inselspital Bern, University Hospital, University of Bern; Pediatric Neurology (B.G.S.), Institute of Pediatrics of Southern Switzerland, San Giovanni Hospital Bellinzona, Ente Ospedaliero Cantonale, Switzerland; Section of Pediatric Neurology, Department of Pediatrics and Child Health (M.F.R.), University of Manitoba, Children's Hospital Research Institute of Manitoba, Canada; Division of Neurology, Department of Pediatrics (M.C., W.D.L.), The Ohio State University and Nationwide Children's Hospital, Columbus; Division of Neurology (L.A.B., L.L.B.), Children's Hospital of Philadelphia; Departments of Neurology and Pediatrics (L.A.B., L.L.B.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Departments of Neurology and Pediatrics (C.K.F.), University of California, San Francisco; Unit of Clinical Epidemiology (A.P.), Ente Ospedaliero Cantonale, Bellinzona; Division of Pneumology (A.P.), University of Geneva, Switzerland; and Department of Neurology (M.T.M.), Royal Children's Hospital Melbourne, Murdoch Children's Research Institute Melbourne, Parkville, Victoria, Australia
| | - Melissa Chung
- From the Neurovascular Research Group, Department of Neurology (B.G.S.), and Division of Child Neurology, Department of Pediatrics (B.G.S., M.S.), Inselspital Bern, University Hospital, University of Bern; Pediatric Neurology (B.G.S.), Institute of Pediatrics of Southern Switzerland, San Giovanni Hospital Bellinzona, Ente Ospedaliero Cantonale, Switzerland; Section of Pediatric Neurology, Department of Pediatrics and Child Health (M.F.R.), University of Manitoba, Children's Hospital Research Institute of Manitoba, Canada; Division of Neurology, Department of Pediatrics (M.C., W.D.L.), The Ohio State University and Nationwide Children's Hospital, Columbus; Division of Neurology (L.A.B., L.L.B.), Children's Hospital of Philadelphia; Departments of Neurology and Pediatrics (L.A.B., L.L.B.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Departments of Neurology and Pediatrics (C.K.F.), University of California, San Francisco; Unit of Clinical Epidemiology (A.P.), Ente Ospedaliero Cantonale, Bellinzona; Division of Pneumology (A.P.), University of Geneva, Switzerland; and Department of Neurology (M.T.M.), Royal Children's Hospital Melbourne, Murdoch Children's Research Institute Melbourne, Parkville, Victoria, Australia
| | - Warren D Lo
- From the Neurovascular Research Group, Department of Neurology (B.G.S.), and Division of Child Neurology, Department of Pediatrics (B.G.S., M.S.), Inselspital Bern, University Hospital, University of Bern; Pediatric Neurology (B.G.S.), Institute of Pediatrics of Southern Switzerland, San Giovanni Hospital Bellinzona, Ente Ospedaliero Cantonale, Switzerland; Section of Pediatric Neurology, Department of Pediatrics and Child Health (M.F.R.), University of Manitoba, Children's Hospital Research Institute of Manitoba, Canada; Division of Neurology, Department of Pediatrics (M.C., W.D.L.), The Ohio State University and Nationwide Children's Hospital, Columbus; Division of Neurology (L.A.B., L.L.B.), Children's Hospital of Philadelphia; Departments of Neurology and Pediatrics (L.A.B., L.L.B.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Departments of Neurology and Pediatrics (C.K.F.), University of California, San Francisco; Unit of Clinical Epidemiology (A.P.), Ente Ospedaliero Cantonale, Bellinzona; Division of Pneumology (A.P.), University of Geneva, Switzerland; and Department of Neurology (M.T.M.), Royal Children's Hospital Melbourne, Murdoch Children's Research Institute Melbourne, Parkville, Victoria, Australia
| | - Lauren A Beslow
- From the Neurovascular Research Group, Department of Neurology (B.G.S.), and Division of Child Neurology, Department of Pediatrics (B.G.S., M.S.), Inselspital Bern, University Hospital, University of Bern; Pediatric Neurology (B.G.S.), Institute of Pediatrics of Southern Switzerland, San Giovanni Hospital Bellinzona, Ente Ospedaliero Cantonale, Switzerland; Section of Pediatric Neurology, Department of Pediatrics and Child Health (M.F.R.), University of Manitoba, Children's Hospital Research Institute of Manitoba, Canada; Division of Neurology, Department of Pediatrics (M.C., W.D.L.), The Ohio State University and Nationwide Children's Hospital, Columbus; Division of Neurology (L.A.B., L.L.B.), Children's Hospital of Philadelphia; Departments of Neurology and Pediatrics (L.A.B., L.L.B.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Departments of Neurology and Pediatrics (C.K.F.), University of California, San Francisco; Unit of Clinical Epidemiology (A.P.), Ente Ospedaliero Cantonale, Bellinzona; Division of Pneumology (A.P.), University of Geneva, Switzerland; and Department of Neurology (M.T.M.), Royal Children's Hospital Melbourne, Murdoch Children's Research Institute Melbourne, Parkville, Victoria, Australia
| | - Lori L Billinghurst
- From the Neurovascular Research Group, Department of Neurology (B.G.S.), and Division of Child Neurology, Department of Pediatrics (B.G.S., M.S.), Inselspital Bern, University Hospital, University of Bern; Pediatric Neurology (B.G.S.), Institute of Pediatrics of Southern Switzerland, San Giovanni Hospital Bellinzona, Ente Ospedaliero Cantonale, Switzerland; Section of Pediatric Neurology, Department of Pediatrics and Child Health (M.F.R.), University of Manitoba, Children's Hospital Research Institute of Manitoba, Canada; Division of Neurology, Department of Pediatrics (M.C., W.D.L.), The Ohio State University and Nationwide Children's Hospital, Columbus; Division of Neurology (L.A.B., L.L.B.), Children's Hospital of Philadelphia; Departments of Neurology and Pediatrics (L.A.B., L.L.B.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Departments of Neurology and Pediatrics (C.K.F.), University of California, San Francisco; Unit of Clinical Epidemiology (A.P.), Ente Ospedaliero Cantonale, Bellinzona; Division of Pneumology (A.P.), University of Geneva, Switzerland; and Department of Neurology (M.T.M.), Royal Children's Hospital Melbourne, Murdoch Children's Research Institute Melbourne, Parkville, Victoria, Australia
| | - Christine K Fox
- From the Neurovascular Research Group, Department of Neurology (B.G.S.), and Division of Child Neurology, Department of Pediatrics (B.G.S., M.S.), Inselspital Bern, University Hospital, University of Bern; Pediatric Neurology (B.G.S.), Institute of Pediatrics of Southern Switzerland, San Giovanni Hospital Bellinzona, Ente Ospedaliero Cantonale, Switzerland; Section of Pediatric Neurology, Department of Pediatrics and Child Health (M.F.R.), University of Manitoba, Children's Hospital Research Institute of Manitoba, Canada; Division of Neurology, Department of Pediatrics (M.C., W.D.L.), The Ohio State University and Nationwide Children's Hospital, Columbus; Division of Neurology (L.A.B., L.L.B.), Children's Hospital of Philadelphia; Departments of Neurology and Pediatrics (L.A.B., L.L.B.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Departments of Neurology and Pediatrics (C.K.F.), University of California, San Francisco; Unit of Clinical Epidemiology (A.P.), Ente Ospedaliero Cantonale, Bellinzona; Division of Pneumology (A.P.), University of Geneva, Switzerland; and Department of Neurology (M.T.M.), Royal Children's Hospital Melbourne, Murdoch Children's Research Institute Melbourne, Parkville, Victoria, Australia
| | - Alberto Pagnamenta
- From the Neurovascular Research Group, Department of Neurology (B.G.S.), and Division of Child Neurology, Department of Pediatrics (B.G.S., M.S.), Inselspital Bern, University Hospital, University of Bern; Pediatric Neurology (B.G.S.), Institute of Pediatrics of Southern Switzerland, San Giovanni Hospital Bellinzona, Ente Ospedaliero Cantonale, Switzerland; Section of Pediatric Neurology, Department of Pediatrics and Child Health (M.F.R.), University of Manitoba, Children's Hospital Research Institute of Manitoba, Canada; Division of Neurology, Department of Pediatrics (M.C., W.D.L.), The Ohio State University and Nationwide Children's Hospital, Columbus; Division of Neurology (L.A.B., L.L.B.), Children's Hospital of Philadelphia; Departments of Neurology and Pediatrics (L.A.B., L.L.B.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Departments of Neurology and Pediatrics (C.K.F.), University of California, San Francisco; Unit of Clinical Epidemiology (A.P.), Ente Ospedaliero Cantonale, Bellinzona; Division of Pneumology (A.P.), University of Geneva, Switzerland; and Department of Neurology (M.T.M.), Royal Children's Hospital Melbourne, Murdoch Children's Research Institute Melbourne, Parkville, Victoria, Australia
| | - Maja Steinlin
- From the Neurovascular Research Group, Department of Neurology (B.G.S.), and Division of Child Neurology, Department of Pediatrics (B.G.S., M.S.), Inselspital Bern, University Hospital, University of Bern; Pediatric Neurology (B.G.S.), Institute of Pediatrics of Southern Switzerland, San Giovanni Hospital Bellinzona, Ente Ospedaliero Cantonale, Switzerland; Section of Pediatric Neurology, Department of Pediatrics and Child Health (M.F.R.), University of Manitoba, Children's Hospital Research Institute of Manitoba, Canada; Division of Neurology, Department of Pediatrics (M.C., W.D.L.), The Ohio State University and Nationwide Children's Hospital, Columbus; Division of Neurology (L.A.B., L.L.B.), Children's Hospital of Philadelphia; Departments of Neurology and Pediatrics (L.A.B., L.L.B.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Departments of Neurology and Pediatrics (C.K.F.), University of California, San Francisco; Unit of Clinical Epidemiology (A.P.), Ente Ospedaliero Cantonale, Bellinzona; Division of Pneumology (A.P.), University of Geneva, Switzerland; and Department of Neurology (M.T.M.), Royal Children's Hospital Melbourne, Murdoch Children's Research Institute Melbourne, Parkville, Victoria, Australia
| | - Mark T Mackay
- From the Neurovascular Research Group, Department of Neurology (B.G.S.), and Division of Child Neurology, Department of Pediatrics (B.G.S., M.S.), Inselspital Bern, University Hospital, University of Bern; Pediatric Neurology (B.G.S.), Institute of Pediatrics of Southern Switzerland, San Giovanni Hospital Bellinzona, Ente Ospedaliero Cantonale, Switzerland; Section of Pediatric Neurology, Department of Pediatrics and Child Health (M.F.R.), University of Manitoba, Children's Hospital Research Institute of Manitoba, Canada; Division of Neurology, Department of Pediatrics (M.C., W.D.L.), The Ohio State University and Nationwide Children's Hospital, Columbus; Division of Neurology (L.A.B., L.L.B.), Children's Hospital of Philadelphia; Departments of Neurology and Pediatrics (L.A.B., L.L.B.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Departments of Neurology and Pediatrics (C.K.F.), University of California, San Francisco; Unit of Clinical Epidemiology (A.P.), Ente Ospedaliero Cantonale, Bellinzona; Division of Pneumology (A.P.), University of Geneva, Switzerland; and Department of Neurology (M.T.M.), Royal Children's Hospital Melbourne, Murdoch Children's Research Institute Melbourne, Parkville, Victoria, Australia
| | | |
Collapse
|
37
|
Rambaud T, Legris N, Bejot Y, Bellesme C, Lapergue B, Jouvent E, Pico F, Smadja D, Zuber M, Crozier S, Lamy C, Spelle L, Tuppin P, Kossorotoff M, Denier C. Acute ischemic stroke in adolescents. Neurology 2019; 94:e158-e169. [PMID: 31831601 DOI: 10.1212/wnl.0000000000008783] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 06/30/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Adolescence represents a transition period between childhood and adulthood, and only limited information exists about stroke characteristics in this population. Our aim was to describe the clinical and neuroradiologic features, etiologies, initial management, and outcome of ischemic stroke in adolescents. METHODS This retrospective cohort study evaluated all consecutive patients 10 to 18 years with a first-ever ischemic stroke hospitalized between 2007 and 2017 in 10 French academic centers representing a population of ≈10 million. Extracted data from the national database served as validation. RESULTS A total of 60 patients were included (53% male, median age 15.2 years). Diagnosis at first medical contact was misevaluated in 36%, more frequently in posterior than anterior circulation strokes (55% vs 20% respectively, odds ratio 4.8, 95% confidence interval 1.41-16.40, p = 0.01). Recanalization treatment rate was high (n = 19, 32%): IV thrombolysis (17%), endovascular therapy (11.7%), or both IV and intra-arterial thrombolysis (3.3%); safety was good (only 1 asymptomatic hemorrhagic transformation). Despite thorough etiologic workup, 50% of strokes remained cryptogenic. The most common determined etiologies were cardioembolism (15%), vasculitis and autoimmune disorders (12%, occurring exclusively in female patients), and arterial dissections (10%, exclusively in male patients). Recurrent ischemic cerebrovascular events occurred in 12% (median follow-up 19 months). Recurrence rate was 50% in patients with identified vasculopathy but 0% after cryptogenic stroke. Functional outcome was favorable (Rankin Scale score 0-2 at day 90) in 80% of cases. CONCLUSIONS Ischemic strokes in adolescents harbor both pediatric and adult features, emphasizing the need for multidisciplinary collaboration in their management. Recanalization treatments appear feasible and safe.
Collapse
Affiliation(s)
- Thomas Rambaud
- From the Stroke Units and Department of Neurology (T.R., N.L., C.D.), Hôpital Bicêtre, Le Kremlin Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris Saclay University; Department of Neurology (Y.B.), University Région Bourgogne, Hôpital de Dijon; Pediatric Neurology Unit (C.B.), Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; Stroke Units and Department of Neurology (B.L.), Hôpital Foch, Suresnes; Department of Neurology (E.J.), Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (F.P.), Hôpital Andre Mignot, Versailles; Department of Neurology (D.S.), Hôpital Sud Francilien, Evry; Department of Neurology (M.Z.), Hôpital Saint Joseph, Paris; Department of Neurology (S.C.), Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (C.L.), Hôpital Sainte Anne, Paris; Interventional Neuroradiology (L.S.), NEURI Centre, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; French National Health Insurance (P.T.); and Pediatric Neurology Unit (M.K.), Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants malades, France
| | - Nicolas Legris
- From the Stroke Units and Department of Neurology (T.R., N.L., C.D.), Hôpital Bicêtre, Le Kremlin Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris Saclay University; Department of Neurology (Y.B.), University Région Bourgogne, Hôpital de Dijon; Pediatric Neurology Unit (C.B.), Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; Stroke Units and Department of Neurology (B.L.), Hôpital Foch, Suresnes; Department of Neurology (E.J.), Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (F.P.), Hôpital Andre Mignot, Versailles; Department of Neurology (D.S.), Hôpital Sud Francilien, Evry; Department of Neurology (M.Z.), Hôpital Saint Joseph, Paris; Department of Neurology (S.C.), Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (C.L.), Hôpital Sainte Anne, Paris; Interventional Neuroradiology (L.S.), NEURI Centre, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; French National Health Insurance (P.T.); and Pediatric Neurology Unit (M.K.), Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants malades, France
| | - Yannick Bejot
- From the Stroke Units and Department of Neurology (T.R., N.L., C.D.), Hôpital Bicêtre, Le Kremlin Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris Saclay University; Department of Neurology (Y.B.), University Région Bourgogne, Hôpital de Dijon; Pediatric Neurology Unit (C.B.), Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; Stroke Units and Department of Neurology (B.L.), Hôpital Foch, Suresnes; Department of Neurology (E.J.), Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (F.P.), Hôpital Andre Mignot, Versailles; Department of Neurology (D.S.), Hôpital Sud Francilien, Evry; Department of Neurology (M.Z.), Hôpital Saint Joseph, Paris; Department of Neurology (S.C.), Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (C.L.), Hôpital Sainte Anne, Paris; Interventional Neuroradiology (L.S.), NEURI Centre, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; French National Health Insurance (P.T.); and Pediatric Neurology Unit (M.K.), Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants malades, France
| | - Céline Bellesme
- From the Stroke Units and Department of Neurology (T.R., N.L., C.D.), Hôpital Bicêtre, Le Kremlin Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris Saclay University; Department of Neurology (Y.B.), University Région Bourgogne, Hôpital de Dijon; Pediatric Neurology Unit (C.B.), Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; Stroke Units and Department of Neurology (B.L.), Hôpital Foch, Suresnes; Department of Neurology (E.J.), Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (F.P.), Hôpital Andre Mignot, Versailles; Department of Neurology (D.S.), Hôpital Sud Francilien, Evry; Department of Neurology (M.Z.), Hôpital Saint Joseph, Paris; Department of Neurology (S.C.), Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (C.L.), Hôpital Sainte Anne, Paris; Interventional Neuroradiology (L.S.), NEURI Centre, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; French National Health Insurance (P.T.); and Pediatric Neurology Unit (M.K.), Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants malades, France
| | - Bertrand Lapergue
- From the Stroke Units and Department of Neurology (T.R., N.L., C.D.), Hôpital Bicêtre, Le Kremlin Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris Saclay University; Department of Neurology (Y.B.), University Région Bourgogne, Hôpital de Dijon; Pediatric Neurology Unit (C.B.), Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; Stroke Units and Department of Neurology (B.L.), Hôpital Foch, Suresnes; Department of Neurology (E.J.), Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (F.P.), Hôpital Andre Mignot, Versailles; Department of Neurology (D.S.), Hôpital Sud Francilien, Evry; Department of Neurology (M.Z.), Hôpital Saint Joseph, Paris; Department of Neurology (S.C.), Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (C.L.), Hôpital Sainte Anne, Paris; Interventional Neuroradiology (L.S.), NEURI Centre, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; French National Health Insurance (P.T.); and Pediatric Neurology Unit (M.K.), Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants malades, France
| | - Eric Jouvent
- From the Stroke Units and Department of Neurology (T.R., N.L., C.D.), Hôpital Bicêtre, Le Kremlin Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris Saclay University; Department of Neurology (Y.B.), University Région Bourgogne, Hôpital de Dijon; Pediatric Neurology Unit (C.B.), Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; Stroke Units and Department of Neurology (B.L.), Hôpital Foch, Suresnes; Department of Neurology (E.J.), Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (F.P.), Hôpital Andre Mignot, Versailles; Department of Neurology (D.S.), Hôpital Sud Francilien, Evry; Department of Neurology (M.Z.), Hôpital Saint Joseph, Paris; Department of Neurology (S.C.), Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (C.L.), Hôpital Sainte Anne, Paris; Interventional Neuroradiology (L.S.), NEURI Centre, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; French National Health Insurance (P.T.); and Pediatric Neurology Unit (M.K.), Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants malades, France
| | - Fernando Pico
- From the Stroke Units and Department of Neurology (T.R., N.L., C.D.), Hôpital Bicêtre, Le Kremlin Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris Saclay University; Department of Neurology (Y.B.), University Région Bourgogne, Hôpital de Dijon; Pediatric Neurology Unit (C.B.), Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; Stroke Units and Department of Neurology (B.L.), Hôpital Foch, Suresnes; Department of Neurology (E.J.), Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (F.P.), Hôpital Andre Mignot, Versailles; Department of Neurology (D.S.), Hôpital Sud Francilien, Evry; Department of Neurology (M.Z.), Hôpital Saint Joseph, Paris; Department of Neurology (S.C.), Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (C.L.), Hôpital Sainte Anne, Paris; Interventional Neuroradiology (L.S.), NEURI Centre, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; French National Health Insurance (P.T.); and Pediatric Neurology Unit (M.K.), Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants malades, France
| | - Didier Smadja
- From the Stroke Units and Department of Neurology (T.R., N.L., C.D.), Hôpital Bicêtre, Le Kremlin Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris Saclay University; Department of Neurology (Y.B.), University Région Bourgogne, Hôpital de Dijon; Pediatric Neurology Unit (C.B.), Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; Stroke Units and Department of Neurology (B.L.), Hôpital Foch, Suresnes; Department of Neurology (E.J.), Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (F.P.), Hôpital Andre Mignot, Versailles; Department of Neurology (D.S.), Hôpital Sud Francilien, Evry; Department of Neurology (M.Z.), Hôpital Saint Joseph, Paris; Department of Neurology (S.C.), Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (C.L.), Hôpital Sainte Anne, Paris; Interventional Neuroradiology (L.S.), NEURI Centre, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; French National Health Insurance (P.T.); and Pediatric Neurology Unit (M.K.), Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants malades, France
| | - Mathieu Zuber
- From the Stroke Units and Department of Neurology (T.R., N.L., C.D.), Hôpital Bicêtre, Le Kremlin Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris Saclay University; Department of Neurology (Y.B.), University Région Bourgogne, Hôpital de Dijon; Pediatric Neurology Unit (C.B.), Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; Stroke Units and Department of Neurology (B.L.), Hôpital Foch, Suresnes; Department of Neurology (E.J.), Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (F.P.), Hôpital Andre Mignot, Versailles; Department of Neurology (D.S.), Hôpital Sud Francilien, Evry; Department of Neurology (M.Z.), Hôpital Saint Joseph, Paris; Department of Neurology (S.C.), Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (C.L.), Hôpital Sainte Anne, Paris; Interventional Neuroradiology (L.S.), NEURI Centre, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; French National Health Insurance (P.T.); and Pediatric Neurology Unit (M.K.), Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants malades, France
| | - Sophie Crozier
- From the Stroke Units and Department of Neurology (T.R., N.L., C.D.), Hôpital Bicêtre, Le Kremlin Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris Saclay University; Department of Neurology (Y.B.), University Région Bourgogne, Hôpital de Dijon; Pediatric Neurology Unit (C.B.), Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; Stroke Units and Department of Neurology (B.L.), Hôpital Foch, Suresnes; Department of Neurology (E.J.), Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (F.P.), Hôpital Andre Mignot, Versailles; Department of Neurology (D.S.), Hôpital Sud Francilien, Evry; Department of Neurology (M.Z.), Hôpital Saint Joseph, Paris; Department of Neurology (S.C.), Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (C.L.), Hôpital Sainte Anne, Paris; Interventional Neuroradiology (L.S.), NEURI Centre, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; French National Health Insurance (P.T.); and Pediatric Neurology Unit (M.K.), Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants malades, France
| | - Catherine Lamy
- From the Stroke Units and Department of Neurology (T.R., N.L., C.D.), Hôpital Bicêtre, Le Kremlin Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris Saclay University; Department of Neurology (Y.B.), University Région Bourgogne, Hôpital de Dijon; Pediatric Neurology Unit (C.B.), Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; Stroke Units and Department of Neurology (B.L.), Hôpital Foch, Suresnes; Department of Neurology (E.J.), Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (F.P.), Hôpital Andre Mignot, Versailles; Department of Neurology (D.S.), Hôpital Sud Francilien, Evry; Department of Neurology (M.Z.), Hôpital Saint Joseph, Paris; Department of Neurology (S.C.), Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (C.L.), Hôpital Sainte Anne, Paris; Interventional Neuroradiology (L.S.), NEURI Centre, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; French National Health Insurance (P.T.); and Pediatric Neurology Unit (M.K.), Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants malades, France
| | - Laurent Spelle
- From the Stroke Units and Department of Neurology (T.R., N.L., C.D.), Hôpital Bicêtre, Le Kremlin Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris Saclay University; Department of Neurology (Y.B.), University Région Bourgogne, Hôpital de Dijon; Pediatric Neurology Unit (C.B.), Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; Stroke Units and Department of Neurology (B.L.), Hôpital Foch, Suresnes; Department of Neurology (E.J.), Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (F.P.), Hôpital Andre Mignot, Versailles; Department of Neurology (D.S.), Hôpital Sud Francilien, Evry; Department of Neurology (M.Z.), Hôpital Saint Joseph, Paris; Department of Neurology (S.C.), Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (C.L.), Hôpital Sainte Anne, Paris; Interventional Neuroradiology (L.S.), NEURI Centre, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; French National Health Insurance (P.T.); and Pediatric Neurology Unit (M.K.), Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants malades, France
| | - Philippe Tuppin
- From the Stroke Units and Department of Neurology (T.R., N.L., C.D.), Hôpital Bicêtre, Le Kremlin Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris Saclay University; Department of Neurology (Y.B.), University Région Bourgogne, Hôpital de Dijon; Pediatric Neurology Unit (C.B.), Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; Stroke Units and Department of Neurology (B.L.), Hôpital Foch, Suresnes; Department of Neurology (E.J.), Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (F.P.), Hôpital Andre Mignot, Versailles; Department of Neurology (D.S.), Hôpital Sud Francilien, Evry; Department of Neurology (M.Z.), Hôpital Saint Joseph, Paris; Department of Neurology (S.C.), Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (C.L.), Hôpital Sainte Anne, Paris; Interventional Neuroradiology (L.S.), NEURI Centre, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; French National Health Insurance (P.T.); and Pediatric Neurology Unit (M.K.), Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants malades, France
| | - Manoelle Kossorotoff
- From the Stroke Units and Department of Neurology (T.R., N.L., C.D.), Hôpital Bicêtre, Le Kremlin Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris Saclay University; Department of Neurology (Y.B.), University Région Bourgogne, Hôpital de Dijon; Pediatric Neurology Unit (C.B.), Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; Stroke Units and Department of Neurology (B.L.), Hôpital Foch, Suresnes; Department of Neurology (E.J.), Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (F.P.), Hôpital Andre Mignot, Versailles; Department of Neurology (D.S.), Hôpital Sud Francilien, Evry; Department of Neurology (M.Z.), Hôpital Saint Joseph, Paris; Department of Neurology (S.C.), Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (C.L.), Hôpital Sainte Anne, Paris; Interventional Neuroradiology (L.S.), NEURI Centre, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; French National Health Insurance (P.T.); and Pediatric Neurology Unit (M.K.), Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants malades, France
| | - Christian Denier
- From the Stroke Units and Department of Neurology (T.R., N.L., C.D.), Hôpital Bicêtre, Le Kremlin Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris Saclay University; Department of Neurology (Y.B.), University Région Bourgogne, Hôpital de Dijon; Pediatric Neurology Unit (C.B.), Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; Stroke Units and Department of Neurology (B.L.), Hôpital Foch, Suresnes; Department of Neurology (E.J.), Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (F.P.), Hôpital Andre Mignot, Versailles; Department of Neurology (D.S.), Hôpital Sud Francilien, Evry; Department of Neurology (M.Z.), Hôpital Saint Joseph, Paris; Department of Neurology (S.C.), Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (C.L.), Hôpital Sainte Anne, Paris; Interventional Neuroradiology (L.S.), NEURI Centre, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; French National Health Insurance (P.T.); and Pediatric Neurology Unit (M.K.), Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants malades, France.
| |
Collapse
|
38
|
Alawadhi A, Saint-Martin C, Sabapathy C, Sebire G, Shevell M. Lateral Medullary Syndrome Due to Left Vertebral Artery Occlusion in a Boy Postflexion Neck Injury. Child Neurol Open 2019; 6:2329048X19867800. [PMID: 31763345 PMCID: PMC6852355 DOI: 10.1177/2329048x19867800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 06/03/2019] [Accepted: 07/14/2019] [Indexed: 11/16/2022] Open
Abstract
Lateral medullary syndrome is rare in pediatrics. It is characterized by neurological
deficits due to an ischemic lesion in the lateral medulla. The authors describe a
17-year-old boy who developed lateral medullary syndrome in the context of a hyperflexion
neck injury while diving in shallow water with traumatic vascular injury. He had “crossed”
neurological deficits above and below the neck. His magnetic resonance angiography showed
intra- and extracranial left vertebral artery occlusion and his magnetic resonance imaging
showed signal abnormality involving the left lateral medulla and inferomedial cerebellum
in keeping with an infarct secondary to left vertebral artery and left posterior inferior
cerebellar artery occlusion. Good neurological recovery was observed on heparin therapy
started after surgical treatment of traumatic injury. To our knowledge, this is the first
reported case of lateral medullary syndrome in a pediatric population related to a flexion
neck injury. The authors emphasize the importance of a high level of suspicion for
accurate diagnosis.
Collapse
Affiliation(s)
- Abdulla Alawadhi
- Division of Pediatric Neurology, Departments of Pediatrics & Neurology/Neurosurgery, The Montreal Children's Hospital, McGill University, Montreal, Québec, Canada
| | - Christine Saint-Martin
- Department of Medical Imaging, The Montreal Children's Hospital, McGill University, Montreal, Québec, Canada.,Department of Radiology, The Montreal Children's Hospital, McGill University, Montreal, Québec, Canada
| | - Christine Sabapathy
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, The Montreal Children's Hospital, McGill University, Montréal, Québec, Canada
| | - Guillaume Sebire
- Division of Pediatric Neurology, Departments of Pediatrics & Neurology/Neurosurgery, The Montreal Children's Hospital, McGill University, Montreal, Québec, Canada
| | - Michael Shevell
- Division of Pediatric Neurology, Departments of Pediatrics & Neurology/Neurosurgery, The Montreal Children's Hospital, McGill University, Montreal, Québec, Canada
| |
Collapse
|
39
|
Thompson EJ, Wildman-Tobriner B, Parente V. Case 1: Delayed Diagnosis in a 13-year-old with Persistent Neurologic Symptoms after a Carnival Ride. Pediatr Rev 2019; 40:359-361. [PMID: 31263044 DOI: 10.1542/pir.2017-0270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
40
|
Nash M, Rafay MF. Craniocervical Arterial Dissection in Children: Pathophysiology and Management. Pediatr Neurol 2019; 95:9-18. [PMID: 30955992 DOI: 10.1016/j.pediatrneurol.2019.01.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 01/24/2019] [Accepted: 01/26/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Craniocervical arterial dissection is a commonly reported arteriopathy associated with stroke in children. It is characterized by a high stroke recurrence rate and variable outcomes. Here we review the pathophysiology, clinical presentation, and diagnostic neuroimaging approaches that are helpful in accurate diagnosis and follow-up of children with arterial dissection. METHODS MEDLINE searches (2000 to 2018) for articles that contained patients aged less than 18 years with craniocervical arterial dissection was performed, with the goal of analyzing their presenting features, pathophysiological mechanisms, and imaging characteristics and interventions. RESULTS Sixteen articles met the study criteria and reported 182 cases of craniocervical arterial dissection, 68% male, average age 8.6 years. Dissection was associated with head and neck trauma in 56% of the cases and frequently involved the posterior (61%) and extracranial locations (64%); the vertebral artery was the most commonly involved artery (60%). The most common clinical presentation was hemiparesis (80/160, 50%), followed by headache (64/164, 39%). Magnetic resonance imaging was the preferred neuroimaging method, followed by cerebral catheter angiography as a gold standard definitive neurovascular imaging modality when the initial vascular imaging revealed nondiagnostic findings. CONCLUSIONS The diagnosis of arterial dissection requires a high index of suspicion and consideration for detailed neurovascular imaging, including both the cranial and cervical regions. Neurovascular imaging challenges, especially visualization of arterial abnormalities, highlight the importance of appropriate and timely use of specific neurovascular imaging techniques. Magnetic resonance imaging appears to be the preferred neurovascular imaging modality in children with arterial dissection and may obviate the need for invasive cerebral catheter angiography.
Collapse
Affiliation(s)
- Monica Nash
- Department of Nursing, Red River College, Winnipeg, Manitoba, Canada
| | - Mubeen F Rafay
- Section of Pediatric Neurology, Department of Pediatrics and Child Health, University of Manitoba, Manitoba, Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.
| |
Collapse
|
41
|
Abstract
Trauma is the leading cause of morbidity and mortality in the pediatric population. Due to a variety of factors, many pediatric trauma patients are initially evaluated and stabilized at adult hospitals that lack pediatric specific emergency medicine and surgical expertise. While similar to adult patients, the initial evaluation and resuscitation of pediatric patients does differ. Many of these key differences contribute to missed injury and susceptibility to error in the treatment of children. Here, we highlight a variety of differences between pediatric and adult trauma patients and clarify reasoning for these differences. Error traps that are discussed include missed cases of non-accidental trauma, missed blunt cerebrovascular injury, over use of CT (computed tomography) scans with unnecessary radiation exposure, missed small bowel or mesenteric injury, and unrecognized hemodynamic instability.
Collapse
Affiliation(s)
- Shannon N Acker
- Division of Pediatric Surgery, Department of Surgery, University of Colorado School of Medicine, Children's Hospital Colorado, 13123 East 16th Avenue, Box 323, Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Ann M Kulungowski
- Division of Pediatric Surgery, Department of Surgery, University of Colorado School of Medicine, Children's Hospital Colorado, 13123 East 16th Avenue, Box 323, Anschutz Medical Campus, Aurora, CO 80045, USA.
| |
Collapse
|
42
|
Goyal P, Malhotra A, Almast J, Sapire J, Gupta S, Mangla M, Mangla R. Neuroimaging of Pediatric Arteriopathies. J Neuroimaging 2019; 29:287-308. [PMID: 30920080 DOI: 10.1111/jon.12614] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 03/10/2019] [Accepted: 03/14/2019] [Indexed: 01/30/2023] Open
Abstract
Pediatric arteriopathies are increasingly recognized in school-aged children with a variety of presenting symptoms ranging from headache, seizures, encephalopathy, and neuropsychiatric symptoms as well as focal neurologic deficits due to acute ischemic strokes. However, unlike the adult stroke population, there are differences in the clinical manifestations, the stroke mechanism, and risk factors in pediatric ischemic stroke. There has been increasing awareness and recognition of pediatric cerebral arteriopathies as a predominant stroke etiology. Prompt diagnosis of arteriopathies is essential to limit injury and prevent recurrent stroke. Based on predominant vessels involved and clinical symptoms, these arteriopathies can be broadly divided into two categories: large-medium size arteriopathies and small vessel arteriopathies. Each category can be further divided into inflammatory and noninflammatory according to their etiologies. The ability to distinguish between inflammatory and noninflammatory etiologies carries major prognostic implications for acute management and secondary stroke prevention as well as screening for systemic complications and counseling.
Collapse
Affiliation(s)
- Pradeep Goyal
- Department of Radiology, St. Vincent's Medical Center, Bridgeport, CT
| | - Ajay Malhotra
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT
| | - Jeevak Almast
- Department of Radiology, University of Rochester Medical Center, Rochester, NY
| | - Joshua Sapire
- Department of Radiology, St. Vincent's Medical Center, Bridgeport, CT
| | - Sonali Gupta
- Department of Medicine, St. Vincent's Medical Center, Bridgeport, CT
| | - Manisha Mangla
- Department of Public Health, SUNY Upstate Medical University, Syracuse, NY
| | - Rajiv Mangla
- Department of Radiology, SUNY Upstate Medical University, Syracuse, NY
| |
Collapse
|
43
|
Management of Stroke in Neonates and Children: A Scientific Statement From the American Heart Association/American Stroke Association. Stroke 2019; 50:e51-e96. [DOI: 10.1161/str.0000000000000183] [Citation(s) in RCA: 240] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
|
44
|
Ugalde IT, Claiborne MK, Cardenas-Turanzas M, Shah MN, Langabeer JR, Patel R. Risk Factors in Pediatric Blunt Cervical Vascular Injury and Significance of Seatbelt Sign. West J Emerg Med 2018; 19:961-969. [PMID: 30429928 PMCID: PMC6225950 DOI: 10.5811/westjem.2018.9.39429] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 09/05/2018] [Accepted: 09/22/2018] [Indexed: 12/29/2022] Open
Abstract
Introduction Computed tomography angiography (CTA) is used to screen patients for cerebrovascular injury after blunt trauma, but risk factors are not clearly defined in children. This modality has inherent radiation exposure. We set out to better delineate the risk factors associated with blunt cervical vascular injury (BCVI) in children with attention to the predictive value of seatbelt sign of the neck. Methods We collected demographic, clinical and radiographic data from the electronic medical record and a trauma registry for patients less than age 18 years who underwent CTA of the neck in their evaluation at a Level I trauma center from November 2002 to December 2014 (12 years). The primary outcome was BCVI. Results We identified 11,446 pediatric blunt trauma patients of whom 375 (2.7%) underwent CTA imaging. Fifty-three patients (0.4%) were diagnosed with cerebrovascular injuries. The average age of patients was 12.6 years and included 66% males. Nearly half of the population was white (52%). Of those patients who received CTA, 53 (14%) were diagnosed with arterial injury of various grades (I-V). We created models to evaluate factors independently associated with BCVI. The independent predictors associated with BCVI were Injury Severity Score >/= 16 (odds ratio [OR] [2.35]; 95% confidence interval [CI] [1.11-4.99%]), infarct on head imaging (OR [3.85]; 95% CI [1.49-9.93%]), hanging mechanism (OR [8.71]; 95% CI [1.52-49.89%]), cervical spine fracture (OR [3.84]; 95% CI [1.94-7.61%]) and basilar skull fracture (OR [2.21]; 95% CI [1.13-4.36%]). The same independent predictors remained associated with BCVI when excluding hanging mechanism from the multivariate regression analysis. Seatbelt sign of the neck was not associated with BCVI (p=0.68). Conclusion We have found independent predictors of BCVI in pediatric patients. These may help in identifying children that may benefit from screening with CTA of the neck.
Collapse
Affiliation(s)
- Irma T Ugalde
- McGovern Medical School at The University of Texas Health Sciences Center, Department of Emergency Medicine, Houston, Texas
| | - Mary K Claiborne
- Phoenix Children's Hospital, Department of Pediatric Emergency Medicine, Phoenix, Arizona
| | - Marylou Cardenas-Turanzas
- McGovern Medical School at The University of Texas Health Sciences Center, Department of Emergency Medicine, Houston, Texas
| | - Manish N Shah
- McGovern Medical School at The University of Texas Health Sciences Center, Department of Pediatric Surgery and Neurosurgery, Houston, Texas
| | - James R Langabeer
- McGovern Medical School at The University of Texas Health Sciences Center, Department of Emergency Medicine, Houston, Texas.,McGovern Medical School at The University of Texas Health Sciences Center, The University of Texas Health Sciences Center School of Biomedical Informatics, Houston, Texas
| | - Rajan Patel
- McGovern Medical School at The University of Texas Health Sciences Center, Department of Diagnostic and Interventional Radiology, Houston, Texas
| |
Collapse
|
45
|
Herbert JP, Venkataraman SS, Turkmani AH, Zhu L, Kerr ML, Patel RP, Ugalde IT, Fletcher SA, Sandberg DI, Cox CS, Kitagawa RS, Day AL, Shah MN. Pediatric blunt cerebrovascular injury: the McGovern screening score. J Neurosurg Pediatr 2018; 21:639-649. [PMID: 29547069 DOI: 10.3171/2017.12.peds17498] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of this study was to assess the incidence, diagnosis, and treatment of pediatric blunt cerebrovascular injury (BCVI) at a busy Level 1 trauma center and to develop a tool for accurately predicting pediatric BCVI and the need for diagnostic testing. METHODS This is a retrospective cohort study of a prospectively collected database of pediatric patients who had sustained blunt trauma (patient age range 0-15 years) and were treated at a Level 1 trauma center between 2005 and 2015. Digital subtraction angiography, MR angiography, or CT angiography was used to confirm BCVI. Recently, the Utah score has emerged as a screening tool specifically targeted toward evaluating BCVI risk in the pediatric population. Using logistical regression and adding mechanism of injury as a logit, the McGovern score was able to use the Utah score as a starting point to create a more sensitive screening tool to identify which pediatric trauma patients should receive angiographic imaging due to a high risk for BCVI. RESULTS A total of 12,614 patients (mean age 6.6 years) were admitted with blunt trauma and prospectively registered in the trauma database. Of these, 460 (3.6%) patients underwent angiography after blunt trauma: 295 (64.1%), 107 (23.3%), 6 (1.3%), and 52 (11.3%) patients underwent CT angiography, MR angiography, digital subtraction angiography, and a combination of imaging modalities, respectively. The BCVI incidence (n = 21; 0.17%) was lower than that in a comparable adult group (p < 0.05). The mean patient was age 10.4 years with a mean follow-up of 7.5 months. Eleven patients (52.4%) were involved in a motor vehicle collision, with a mean Glasgow Coma Scale score of 8.6. There were 8 patients (38.1%) with carotid canal fracture, 6 patients (28.6%) with petrous bone fracture, and 2 patients (9.5%) with infarction on initial presentation. Eight patients (38.1%) were managed with observation alone. The Denver, modified Memphis, Eastern Association for the Surgery of Trauma (EAST), and Utah scores, which are the currently used screening tools for BCVI, misclassified 6 (28.6%), 6 (28.6%), 7 (33.3%), and 10 (47.6%) patients with BCVI, respectively, as "low risk" and not in need of subsequent angiographic imaging. By incorporating the mechanism of injury into the score, the McGovern score only misclassified 4 (19.0%) children, all of whom were managed conservatively with no treatment or aspirin. CONCLUSIONS With a low incidence of pediatric BCVI and a nonsurgical treatment paradigm, a more conservative approach than the Biffl scale should be adopted. The Denver, modified Memphis, EAST, and Utah scores did not accurately predict BCVI in our equally large cohort. The McGovern score is the first BCVI screening tool to incorporate the mechanism of injury into its screening criteria, thereby potentially allowing physicians to minimize unnecessary radiation and determine which high-risk patients are truly in need of angiographic imaging.
Collapse
Affiliation(s)
- Joseph P Herbert
- 1Department of Neurosurgery, University of Missouri-Columbia, Missouri; and
| | | | | | | | | | | | - Irma T Ugalde
- 6Emergency Medicine, McGovern Medical School at UTHealth, Houston, Texas
| | | | | | | | | | | | | |
Collapse
|
46
|
Mehdi E, Aralasmak A, Toprak H, Yıldız S, Kurtcan S, Kolukisa M, Asıl T, Alkan A. Craniocervical Dissections: Radiologic Findings, Pitfalls, Mimicking Diseases: A Pictorial Review. Curr Med Imaging 2018; 14:207-222. [PMID: 29853818 PMCID: PMC5902863 DOI: 10.2174/1573405613666170403102235] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background: Craniocervical Dissections (CCD) are a crucial emergency state causing 20% of strokes in patients under the age of 45. Although DSA (digital substraction angiography) is regarded as the gold standard, noninvasive methods of CT, CTA and MRI, MRA are widely used for diagnosis. Aim: Our aim is to illustrate noninvasive imaging findings in CCD. Conclusion: Emphasizing on diagnostic pitfalls, limitations and mimicking diseases.
Collapse
Affiliation(s)
- Elnur Mehdi
- Bezmialem Vakif University, Department of Radiology, Istanbul, Turkey
| | - Ayse Aralasmak
- Bezmialem Vakif University, Department of Radiology, Istanbul, Turkey
| | - Huseyin Toprak
- Bezmialem Vakif University, Department of Radiology, Istanbul, Turkey
| | - Seyma Yıldız
- Bezmialem Vakif University, Department of Radiology, Istanbul, Turkey
| | - Serpil Kurtcan
- Bezmialem Vakif University, Department of Radiology, Istanbul, Turkey
| | - Mehmet Kolukisa
- Bezmialem Vakif University, Department of Neurology, Istanbul, Turkey
| | - Talip Asıl
- Bezmialem Vakif University, Department of Neurology, Istanbul, Turkey
| | - Alpay Alkan
- Bezmialem Vakif University, Department of Radiology, Istanbul, Turkey
| |
Collapse
|
47
|
Abstract
Temporal bone fractures can occur as a result of various head trauma. The most common cause of the hemotympanum is traumatic temporal bone fracture. Facial paralysis and hearing loss can be seen associated with temporal bone fracture. The development of the internal carotid artery aneurysm after temporal bone fracture is extremely rare. In this article, the authors evaluated carotid artery aneurysm that developed after temporal fracture and aneurism compressed by coagulated blood mass which showed itself as a hemotympanum. The internal carotid artery aneurysm that induced by temporal bone fracture and presented as hemotympanum has not been reported yet. This patient is the first case in the literature. Diagnosis, treatment, and follow-up options will be discussed in the light of current literature.
Collapse
|
48
|
Zhurkabayeva BD, Askarova AE, Berdina OD. A role of infection in the development of hemorrhagic stroke in children. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 118:31-37. [DOI: 10.17116/jnevro20181185231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
49
|
Fox CK, Hills NK, Vinson DR, Numis AL, Dicker RA, Sidney S, Fullerton HJ. Population-based study of ischemic stroke risk after trauma in children and young adults. Neurology 2017; 89:2310-2316. [PMID: 29117963 PMCID: PMC5719927 DOI: 10.1212/wnl.0000000000004708] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 08/16/2017] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To quantify the incidence, timing, and risk of ischemic stroke after trauma in a population-based young cohort. METHODS We electronically identified trauma patients (<50 years old) from a population enrolled in a Northern Californian integrated health care delivery system (1997-2011). Within this cohort, we identified cases of arterial ischemic stroke within 4 weeks of trauma and 3 controls per case. A physician panel reviewed medical records, confirmed cases, and adjudicated whether the stroke was related to trauma. We calculated the 4-week stroke incidence and estimated stroke odds ratios (OR) by injury location using logistic regression. RESULTS From 1,308,009 trauma encounters, we confirmed 52 trauma-related ischemic strokes. The 4-week stroke incidence was 4.0 per 100,000 encounters (95% confidence interval [CI] 3.0-5.2). Trauma was multisystem in 26 (50%). In 19 (37%), the stroke occurred on the day of trauma, and all occurred within 15 days. In 7/28 cases with cerebrovascular angiography at the time of trauma, no abnormalities were detected. In unadjusted analyses, head, neck, chest, back, and abdominal injuries increased stroke risk. Only head (OR 4.1, CI 1.1-14.9) and neck (OR 5.6, CI 1.03-30.9) injuries remained associated with stroke after adjusting for demographics and trauma severity markers (multisystem trauma, motor vehicle collision, arrival by ambulance, intubation). CONCLUSIONS Stroke risk is elevated for 2 weeks after trauma. Onset is frequently delayed, providing an opportunity for stroke prevention during this period. However, in one-quarter of stroke cases with cerebrovascular angiography at the time of trauma, no vascular abnormality was detected.
Collapse
Affiliation(s)
- Christine K Fox
- From the Departments of Neurology (C.K.F., A.L.N., H.J.F.), Pediatrics (C.K.F., A.L.N., H.J.F.), Epidemiology and Biostatistics (N.K.H.), and Surgery (R.A.D.), University of California, San Francisco; the Division of Research (D.R.V., S.S.), Kaiser Permanente Northern California, Oakland; and the Department of Emergency Medicine (D.R.V.), Kaiser Permanente Sacramento Medical Center, Sacramento, CA.
| | - Nancy K Hills
- From the Departments of Neurology (C.K.F., A.L.N., H.J.F.), Pediatrics (C.K.F., A.L.N., H.J.F.), Epidemiology and Biostatistics (N.K.H.), and Surgery (R.A.D.), University of California, San Francisco; the Division of Research (D.R.V., S.S.), Kaiser Permanente Northern California, Oakland; and the Department of Emergency Medicine (D.R.V.), Kaiser Permanente Sacramento Medical Center, Sacramento, CA
| | - David R Vinson
- From the Departments of Neurology (C.K.F., A.L.N., H.J.F.), Pediatrics (C.K.F., A.L.N., H.J.F.), Epidemiology and Biostatistics (N.K.H.), and Surgery (R.A.D.), University of California, San Francisco; the Division of Research (D.R.V., S.S.), Kaiser Permanente Northern California, Oakland; and the Department of Emergency Medicine (D.R.V.), Kaiser Permanente Sacramento Medical Center, Sacramento, CA
| | - Adam L Numis
- From the Departments of Neurology (C.K.F., A.L.N., H.J.F.), Pediatrics (C.K.F., A.L.N., H.J.F.), Epidemiology and Biostatistics (N.K.H.), and Surgery (R.A.D.), University of California, San Francisco; the Division of Research (D.R.V., S.S.), Kaiser Permanente Northern California, Oakland; and the Department of Emergency Medicine (D.R.V.), Kaiser Permanente Sacramento Medical Center, Sacramento, CA
| | - Rochelle A Dicker
- From the Departments of Neurology (C.K.F., A.L.N., H.J.F.), Pediatrics (C.K.F., A.L.N., H.J.F.), Epidemiology and Biostatistics (N.K.H.), and Surgery (R.A.D.), University of California, San Francisco; the Division of Research (D.R.V., S.S.), Kaiser Permanente Northern California, Oakland; and the Department of Emergency Medicine (D.R.V.), Kaiser Permanente Sacramento Medical Center, Sacramento, CA
| | - Stephen Sidney
- From the Departments of Neurology (C.K.F., A.L.N., H.J.F.), Pediatrics (C.K.F., A.L.N., H.J.F.), Epidemiology and Biostatistics (N.K.H.), and Surgery (R.A.D.), University of California, San Francisco; the Division of Research (D.R.V., S.S.), Kaiser Permanente Northern California, Oakland; and the Department of Emergency Medicine (D.R.V.), Kaiser Permanente Sacramento Medical Center, Sacramento, CA
| | - Heather J Fullerton
- From the Departments of Neurology (C.K.F., A.L.N., H.J.F.), Pediatrics (C.K.F., A.L.N., H.J.F.), Epidemiology and Biostatistics (N.K.H.), and Surgery (R.A.D.), University of California, San Francisco; the Division of Research (D.R.V., S.S.), Kaiser Permanente Northern California, Oakland; and the Department of Emergency Medicine (D.R.V.), Kaiser Permanente Sacramento Medical Center, Sacramento, CA
| |
Collapse
|
50
|
Wintermark M, Hills NK, DeVeber GA, Barkovich AJ, Bernard TJ, Friedman NR, Mackay MT, Kirton A, Zhu G, Leiva-Salinas C, Hou Q, Fullerton HJ. Clinical and Imaging Characteristics of Arteriopathy Subtypes in Children with Arterial Ischemic Stroke: Results of the VIPS Study. AJNR Am J Neuroradiol 2017; 38:2172-2179. [PMID: 28982784 DOI: 10.3174/ajnr.a5376] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 07/06/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Childhood arteriopathies are rare but heterogenous, and difficult to diagnose and classify, especially by nonexperts. We quantified clinical and imaging characteristics associated with childhood arteriopathy subtypes to facilitate their diagnosis and classification in research and clinical settings. MATERIALS AND METHODS The Vascular Effects of Infection in Pediatric Stroke (VIPS) study prospectively enrolled 355 children with arterial ischemic stroke (2010-2014). A central team of experts reviewed all data to diagnose childhood arteriopathy and classify subtypes, including arterial dissection and focal cerebral arteriopathy-inflammatory type, which includes transient cerebral arteriopathy, Moyamoya disease, and diffuse/multifocal vasculitis. Only children whose stroke etiology could be conclusively diagnosed were included in these analyses. We constructed logistic regression models to identify characteristics associated with each arteriopathy subtype. RESULTS Among 127 children with definite arteriopathy, the arteriopathy subtype could not be classified in 18 (14%). Moyamoya disease (n = 34) occurred mostly in children younger than 8 years of age; focal cerebral arteriopathy-inflammatory type (n = 25), in children 8-15 years of age; and dissection (n = 26), at all ages. Vertigo at stroke presentation was common in dissection. Dissection affected the cervical arteries, while Moyamoya disease involved the supraclinoid internal carotid arteries. A banded appearance of the M1 segment of the middle cerebral artery was pathognomonic of focal cerebral arteriopathy-inflammatory type but was present in <25% of patients with focal cerebral arteriopathy-inflammatory type; a small lenticulostriate distribution infarct was a more common predictor of focal cerebral arteriopathy-inflammatory type, present in 76%. It remained difficult to distinguish focal cerebral arteriopathy-inflammatory type from intracranial dissection of the anterior circulation. We observed only secondary forms of diffuse/multifocal vasculitis, mostly due to meningitis. CONCLUSIONS Childhood arteriopathy subtypes have some typical features that aid diagnosis. Better imaging methods, including vessel wall imaging, are needed for improved classification of focal cerebral arteriopathy of childhood.
Collapse
Affiliation(s)
- M Wintermark
- From the Department of Radiology (M.W.), Neuroradiology Division, Stanford University, Stanford, California
| | - N K Hills
- Departments of Neurology (N.K.H., H.J.F.).,Biostatistics and Epidemiology (N.K.H.)
| | - G A DeVeber
- Department of Neurology (G.A.D.), Hospital for Sick Children, Toronto, Ontario, Canada
| | - A J Barkovich
- Radiology (A.J.B., H.J.F.).,Pediatrics (A.J.B.),University of California, San Francisco, San Francisco, California
| | - T J Bernard
- Department of Pediatrics (T.J.B.), University of Colorado, Denver, Colorado
| | - N R Friedman
- Center for Pediatric Neurology (N.R.F.), Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - M T Mackay
- Children's Stroke Program (M.T.M.), Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - A Kirton
- Departments of Pediatrics and Clinical Neurosciences (A.K.), Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada
| | - G Zhu
- Department of Neurology (G.Z.), Military General Hospital of Beijing PLA, Beijing, China
| | - C Leiva-Salinas
- Department of Radiology (C.L.-S.), University of Virginia, Charlottesville, Virginia
| | - Q Hou
- Department of Neurology (Q.H.), Guangdong No.2 Provincial People's Hospital, Guangzhou, China
| | - H J Fullerton
- Departments of Neurology (N.K.H., H.J.F.).,Radiology (A.J.B., H.J.F.)
| | | |
Collapse
|