David M Mirsky1, Lauren A Beslow2, Catherine Amlie-Lefond3, Pradeep Krishnan4, Suzanne Laughlin4, Sarah Lee5, Laura Lehman6, Mubeen Rafay7, Dennis Shaw8, Michael J Rivkin9, Max Wintermark10. 1. Department of Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado. Electronic address: david.mirsky@childrenscolorado.org. 2. Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. 3. Department of Neurology, Seattle Children's Hospital, University of Washington, Seattle, Washington. 4. Division of Neuroradiology, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada. 5. Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford, California. 6. Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts. 7. Section of Neurology, Children's Hospital, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada. 8. Department of Radiology, University of Washington School of Medicine, Seattle, Washington. 9. Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts. 10. Division of Neuroradiology, Department of Radiology, Stanford University School of Medicine, Stanford, California.
Abstract
BACKGROUND: The purpose of this article is to aid practitioners in choosing appropriate neuroimaging for children who present with symptoms that could be caused by stroke. METHODS: The Writing Group members participated in one or more pediatric stroke neuroimaging symposiums hosted by the Stroke Imaging Laboratory for Children housed at the Hospital for Sick Children in Toronto, Ontario, Canada. Through collaboration, literature review, and discussion among child neurologists with expertise diagnosing and treating childhood stroke and pediatric neuroradiologists and neuroradiologists with expertise in pediatric neurovascular disease, suggested imaging protocols are presented for children with suspected stroke syndromes including arterial ischemic stroke, cerebral sinovenous thrombosis, and hemorrhagic stroke. RESULTS: This article presents information about the epidemiology and classification of childhood stroke with definitions based on the National Institutes of Health Common Data Elements. The role of imaging for the diagnosis of childhood stroke is examined in depth, with separate sections for arterial ischemic stroke, cerebral sinovenous thrombosis, and hemorrhagic stroke. Abbreviated neuroimaging protocols for rapid diagnosis are discussed. The Writing Group provides suggestions for optimal neuroimaging investigation of various stroke types in the acute setting and suggestions for follow-up neuroimaging. Advanced sequences such as diffusion tensor imaging, perfusion imaging, and vessel wall imaging are also discussed. CONCLUSIONS: This article provides protocols for the imaging of children who present with suspected stroke.
BACKGROUND: The purpose of this article is to aid practitioners in choosing appropriate neuroimaging for children who present with symptoms that could be caused by stroke. METHODS: The Writing Group members participated in one or more pediatric stroke neuroimaging symposiums hosted by the Stroke Imaging Laboratory for Children housed at the Hospital for Sick Children in Toronto, Ontario, Canada. Through collaboration, literature review, and discussion among child neurologists with expertise diagnosing and treating childhood stroke and pediatric neuroradiologists and neuroradiologists with expertise in pediatric neurovascular disease, suggested imaging protocols are presented for children with suspected stroke syndromes including arterial ischemic stroke, cerebral sinovenous thrombosis, and hemorrhagic stroke. RESULTS: This article presents information about the epidemiology and classification of childhood stroke with definitions based on the National Institutes of Health Common Data Elements. The role of imaging for the diagnosis of childhood stroke is examined in depth, with separate sections for arterial ischemic stroke, cerebral sinovenous thrombosis, and hemorrhagic stroke. Abbreviated neuroimaging protocols for rapid diagnosis are discussed. The Writing Group provides suggestions for optimal neuroimaging investigation of various stroke types in the acute setting and suggestions for follow-up neuroimaging. Advanced sequences such as diffusion tensor imaging, perfusion imaging, and vessel wall imaging are also discussed. CONCLUSIONS: This article provides protocols for the imaging of children who present with suspected stroke.
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