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Carla R. Conceição 1, Rita Lopes da Silva 2, Joana N. Ramalho 1

1. Department of Neuroradiology, Hospital Dona Estefânia (Pediatric Hospital), Centro Hospitalar de Lisboa Central, EPE, Lisboa, Portugal
2. Department of Pediatric Neurology, Hospital Dona Estefânia (Pediatric Hospital), Centro Hospitalar de Lisboa Central, EPE, Lisboa, Portugal

Publicação sob forma integral – Capítulo de livro

In: Vascular Imaging of the Central Nervous System: Physical Principles, Clinical Applications, and Emerging Techniques; Pages: 371–404, 2013
Editors: Joana N. Ramalho, Mauricio Castillo
ISBN: 978-1-118-18875-0
March 2014, Wiley-Blackwell


Pediatric stroke has an incidence rate of 2–13/100 000 and it is higher in the first year of age, especially in neonates. In children, 55% have ischemic and 45% hemorrhagic stroke, in contrast with adults, in whom 80–85% of stroke is ischemic. However, the main difference between these ages is the greater diversity of etiologies in pediatric stroke - vasculopathies and/ or cardiologic, hematological, genetic, or metabolic disorders.

There is often a significant delay in the diagnosis of stroke, with more than 24 h from clinical onset to radiologic confirmation of ischemic stroke. In general and compared to adults, imaging studies have a greater role in the evaluation of pediatric stroke, due to his higher clinical variability, stroke-like diseases and differential diagnoses – such as migraine, encephalitis, Todd’s paralysis and tumors that are more frequent than stroke in childhood.

Different imaging techniques can be used to evaluate brain parenchyma and intracranial and extracranial vessels in children, helping in the correct diagnosis and characterization of neurovascular pediatric pathology. The choice of which imaging technique to perform is influenced not only by clinical factors but also by nonclinical factors.

This chapter addresses in the first part the different vascular imaging techniques and in the second part its clinical applications, with a final clinical vignette and suggestions for further reading.

General advantages, limitations and imaging abnormalities of vascular imaging techniques are presented, with a greater focus on computed tomography (CT) and mainly magnetic resonance imaging (MRI), including several CT and MRI applications, but also covering cranial ultrasound, doppler imaging and conventional angiography.

Regarding clinical applications and for description purposes, the pathologies were separated into arterial ischemic stroke, hemorrhagic stroke (nontraumatic), and venous thrombosis. A fourth group, perinatal stroke, was included due to the specificity of clinical and imaging features at this age.

Some clinical aspects but especially imaging aspects are presented, with a larger part of the chapter dedicated to arterial ischemic stroke and the most common etiologies - arteriopathies (50–80%), congenital or acquired cardiac disease and sickle cell disease (SCD) - but also thrombophilias, infections, arterial dissection and some genetic and metabolic diseases. A smaller part is dedicated to hemorrhagic stroke, cerebral sinovenous thrombosis and perinatal stroke.

Keywords - Pediatric stroke; ischemic stroke; hemorrhagic stroke; imaging techniques; MRI; CT