Pediatric Stroke: Clinico-Radiological Correlation

Abstract

Background Pediatric Stroke (PS) is a major cause of morbidity and mortality in children worldwide. The reported annual incidence of childhood stroke ranges from 2.3 to 13 per 100,000 children per year in developed countries. Aim of the Work The objective is to correlate between radiological findings and clinical Findings, provide practitioners with a guide for neuroimaging children with various stroke subtypes. Patients and Methods A cross sectional study was conducted at Ain Shams University Hospital, Radiodiagnosis department. The study period was 6 months, Patients with radiologically proven pediatric stroke using one or more of the following modality (CT, MRI or DSA). The type of study design was a cross sectional study. The study included all images fulfilling the study inclusion criteria in the period from January 2017 till May 2021. Clinical data and imaging findings of the included patients were retrospectively obtained from the picture archive and communication system (PACS, Synapse 5.7. 002. Fujifilm Medical System) of the radiology department, Ain Shams University Hospitals. Results The current study showed that eleven cases (64.6%) started neuro-imaging studies with CT brain & six cases (35.3%) started with MRI stroke protocol with MRV sequence. Diagnosis of stroke was missed in (36.4%) of cases which started with CT brain. Then, MRI stroke protocol was done for these cases in addition to MV sequence. Abbreviated MRI protocols have emerged as an alternative to standard MRI protocols. These abbreviated MRI protocols seek to reduce longer MRI protocols by eliminating unnecessary or redundant sequences that negatively affect cost, MRI table time, time of anesthesia list, image quality, and image interpretation time. Some institutions have developed shortened brain MRI protocols which include diffusion-weighted imaging (DWI), apparent diffusion coefficient (ADC) maps, hemorrhage specific sequences such as susceptibility-weighted imaging (SWI) or gradient echo (GRE), and time-of-flight (TOF) MR-angiogram (MRA). Conclusion Pediatric stroke is relatively rare but can lead to significant morbidity and mortality. Because incidence is much lower than the adult population and presentation is distinctly different, ongoing challenges exist in development of proven screening tools & diagnostic protocol.