The correlation between magnetic resonance angiography findings and the aetiology of childhood arterial ischemic stroke

Abstract

Objective – To describe the magnetic resonance imaging (MRI) and time-of-flight (TOF)-magnetic resonance angiography (MRA) characteristics of children with arterial ischemic stroke and correlate them with the aetiology.

Methods – We performed a retrospective review of clinical records and imaging (MRI and MRA) of 34 children (8 months to 17 years) with arterial ischemic stroke.

Results – The group contained 14 females and 20 males. Risk factors were congenital heart disease (CHD) in 8, sickle cell disease in 2, prothrombotic abnormalities in 7, vasculitis in 5 (varicella in 2, neuroborreliosis in 1), trauma in 3, steno-occlusive cerebral arteriopathy, herniation due to intracranial bleeding, complication of aneurysmal subarachnoid haemorrhage with vasospasm, and arterial dissection with and without previous trauma. In 5 of the 34 patients the aetiology was undetermined. The most common infarctions were observed in the distribution of the middle cerebral artery, followed by the posterior circulation. The intracranial MRA was normal in 15 of the 34 children. In all but one patient with cryptogenic stroke MRA was normal.

Conclusion – MRI is helpful to determine the exact location and limit of the infarct zone. The absence of cerebral arteriopathy on TOF-MRA in childhood stroke suggests a nonvascular cause; mainly cryptogenic stroke, but also prothrombotic abnormalities and CHD.