Pediatric stroke | Figure 1

CincyKidsRad

Cincinnati Children's Radiology

Pediatric Stroke

Axial non-contrast CT demonstrates abnormal decreased attenuation (arrow) within the left middle cerebral artery territory and a smaller area of decreased attenuation (arrowhead) within the anterior right middle cerebral artery territory. Pediatric stroke, though uncommon, presents differently in children compared to adults. In neonates, the most common symptom is seizure, while older children more frequently show focal deficits. However, seizures also occur in approximately 40% of older children. Common risk factors include vasculopathies, infections, cardiac conditions, and coagulopathies.

Continuation of the HSA Case

After the patient had placed the external ventricular shunt, the patient was referred to the endovascular treatment center where a cerebral vessel arteriography was performed with the use of a 3D reconstruction to reduce the time of examination and contrast in the patient. A baby aneurysm was diagnosed in the bifurcation of the carotid artery and another ruptured bilocular aneurysm of the large neck in the right middle cerebral artery, which caused HSA. Thus, we started the endovascular treatment with the use of a balloon microcatheter to stabilize and help to place the micromoles within the large neck aneurysm with greater precision and without the risk of them entering the light of the middle cerebral artery and obstructing it, causing further damage. After placing the micromoles in the ruptured aneurysm, we removed the microballoon and performed a final arteriography to visualize the aneurysm closure and ensure there were no evident damages in the vessels of the middle cerebral artery where everything was within normality and the aneurysm was successfully treated. Diagnostic conclusion: right hemisphere HSA caused by acute middle cerebral artery aneurysm bleeding treated.

Cases

Large infarct, rt middle cerebral artery distribution, diffusion MRI, 60s male.

Patient, 56 years old. A stroke in the left middle cerebral artery after an air embolism.

Positive "dot sign" consistent with insular middle cerebral artery thrombosis.

A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis.

A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back.

A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days.

Patient in late teens presenting after a collapse, no chest pain, no previous cardiac history.