Intracranial Dissection Research Articles

Giant space-occupying intracranial dissecting aneurysm

Giant space-occupying intracranial dissecting aneurysm

Intracranial Arterial Dissection

Introduction: Intracranial dissections (ID) were once considered to be rare. Nevertheless, they cause 5 to 20% of ischemic strokes in children and young adults. Even nowadays in Uruguay, angiography is not frequently performed in patients with evidence of ischemic vascular disorders. Consequently, the available data may underestimate its real prevalence. Materials and methods: Cohort study including all patients who were diagnosed with arterial dissection, using digital angiography, in a period of 10 years, from August 2000 to August 2010. A total of 69 patients, ages 2 to 69, with and without history of trauma were included. The clinical presentation was subarachnoid hemorrhage (SAH) and / or brain ischemia. The average follow-up was 2 years. Results: From 69 cases, 20 were children under 15 year-old, and 49 were over 15 year-old. Patients presented with ischaemic stroke in 35 cases, and hemorrhagic stroke in 34. Thirty seven patients (54%) presented arterial dissections of the posterior circulation. It should be noted that the clinical presentation for posterior fossa dissections was mostly subarachnoid hemorrhage (SAH) (67%). On the contrary, the anterior circulation showed a large majority of ischemic strokes (72%) compared with SAH (28%). Subsequently, 31 dissecting aneurysm were diagnosed and treated, using different endovascular techniques. Of the 31 cases which were treated 4 died (14%) after treatment related to the underlying pathology, 18 (56%) had good evolution of symptoms, and 10 (30%) developed some kind of neurologic impairment. Conclusions: Endovascular treatment is the treatment of choice for dissecting aneurysms, being an effective and safe treatment. In cases of dissection without SAH or dissecting aneurysms, treatment of choice is medical treatment with anticoagulation.

Internal carotid artery dissection

Arterial dissection results from bleeding into the vessel wall. Some cases are associated with cervical trauma or have evidence of an underlying vascular disease; many occur without any history of injury or detectable arterial disease. Among the cervical cephalic arteries, the extracranial segment of the internal carotid artery is the vessel most commonly involved; intracranial carotid dissections are much rare. Carotid dissection occurs predominantly in young or middle-aged adults and shows no sex predominance. Although clinical manifestations can be extremely diverse (from isolated headache to rapidly lethal stroke), the most common and suggestive syndrome associates "local" symptoms (such as head or neck pain, Horner's syndrome, pulsatile tinnitus or lower cranial nerves palsy) and delayed (up to several weeks) symptoms of cerebral ischaemia in the territory of the internal carotid artery territory. Dissection can be bilateral or associated with dissection of the vertebral artery. Angiography has long been considered the gold standard for the diagnosis. As this procedure carries a risk of cerebral complications, noninvasive diagnostic approaches such as magnetic resonance imaging and ultrasound have been developed and are increasingly used. The prognosis of carotid dissections depends on the presence and severity of ischaemic brain damage. Recurrent dissections seem extremely rare. Normalization or improvement of the vascular abnormalities during the subsequent weeks is frequent and is an excellent argument in favour of the diagnosis. Although no controlled trial has ever been performed, anticoagulant treatment is often used for a few months when the dissection involves the extracranial segment of the carotid artery. No standard treatment of intracranial carotid dissection has emerged.

Feasibility of improved motion-sensitized driven-equilibrium (iMSDE) prepared 3D T1-weighted imaging in the diagnosis of vertebrobasilar artery dissection

Background and purposeThis study was to evaluate the diagnostic value of improved motion-sensitized driven-equilibrium (iMSDE)-prepared 3D T1-weighted magnetic resonance imaging (MRI) (iMSDE-3DMRI) in intracranial vertebrobasilary dissection (VBD) and to compare iMSDE-3DMRI images with those obtained using 2D high-resolution (HR) MRI with respect to their diagnostic performance in VBD. Materials and methodsWe retrospectively reviewed 105 lesions from 102 patients who underwent multimodal imaging and contrast-enhanced iMSDE-3DMRI (CE-iMSDE-3DMRI). The 2D-HRMRI protocol comprised four axial HR images. The CE-iMSDE-3DMRI images were reformatted in the axial, coronal, and sagittal planes. The 2D-HRMRI-based diagnosis was compared with the final diagnosis. The 2D-HRMRI and CE-iMSDE-3DMRI images were examined independently for the diagnosis performance of dissection. ResultsVBD was confirmed in 66 lesions in 63 patients; 17 patients had confirmed atherosclerosis, and 22 had no lesions in the vertebrobasilar artery. Diagnostic performances of 2D-HRMRI (AUC, 0.839±0.04; sensitivity, 94.0; specificity, 79.5; diagnostic accuracy, 88.6) CE-iMSDE-3DMRI (AUC, 0.847±0.04; sensitivity, 84.8; specificity, 84.6; diagnostic accuracy, 84.7) and 2D-HRMRI+CE-iMSDE-3DMRI (AUC, 0.893±0.03; sensitivity, 97.0; specificity, 85.0; diagnostic accuracy, 92.5) were good. Comparisons of the diagnostic performance of 2D-HRMRI andCE-iMSDE-3DMRI showed that combined interpretation of 2D-HRMRI and iMSDE-3DMRI yields a significantly higher diagnostic performance than that of 2D-HRMRI (P=0.042). ConclusionsCE-iMSDE-3DMRI showed good diagnostic performance for the diagnosis of intracranial VBD. These results suggest that CE-iMSDE-3DMRI can be used in combination with 2D-HRMRI for the diagnosis of intracranial VBD.

Clinical and Imaging Characteristics of Arteriopathy Subtypes in Children with Arterial Ischemic Stroke: Results of the VIPS Study.

Childhood arteriopathies are rare but heterogenous, and difficult to diagnose and classify, especially by nonexperts. We quantified clinical and imaging characteristics associated with childhood arteriopathy subtypes to facilitate their diagnosis and classification in research and clinical settings. The Vascular Effects of Infection in Pediatric Stroke (VIPS) study prospectively enrolled 355 children with arterial ischemic stroke (2010-2014). A central team of experts reviewed all data to diagnose childhood arteriopathy and classify subtypes, including arterial dissection and focal cerebral arteriopathy-inflammatory type, which includes transient cerebral arteriopathy, Moyamoya disease, and diffuse/multifocal vasculitis. Only children whose stroke etiology could be conclusively diagnosed were included in these analyses. We constructed logistic regression models to identify characteristics associated with each arteriopathy subtype. Among 127 children with definite arteriopathy, the arteriopathy subtype could not be classified in 18 (14%). Moyamoya disease (n = 34) occurred mostly in children younger than 8 years of age; focal cerebral arteriopathy-inflammatory type (n = 25), in children 8-15 years of age; and dissection (n = 26), at all ages. Vertigo at stroke presentation was common in dissection. Dissection affected the cervical arteries, while Moyamoya disease involved the supraclinoid internal carotid arteries. A banded appearance of the M1 segment of the middle cerebral artery was pathognomonic of focal cerebral arteriopathy-inflammatory type but was present in <25% of patients with focal cerebral arteriopathy-inflammatory type; a small lenticulostriate distribution infarct was a more common predictor of focal cerebral arteriopathy-inflammatory type, present in 76%. It remained difficult to distinguish focal cerebral arteriopathy-inflammatory type from intracranial dissection of the anterior circulation. We observed only secondary forms of diffuse/multifocal vasculitis, mostly due to meningitis. Childhood arteriopathy subtypes have some typical features that aid diagnosis. Better imaging methods, including vessel wall imaging, are needed for improved classification of focal cerebral arteriopathy of childhood.

Risk Factors of Recurrence after Stent(s)-Assisted Coiling of Intracranial Vertebrobasilar Dissecting Aneurysms: A Multicenter Study.

We aimed to evaluate the risk factors of recurrence after stent(s)-assisted coiling (SAC) of intracranial vertebrobasilar dissecting aneurysms (VBDAs) based on 168 consecutive patients. Between January 2011 and December 2015, 168 consecutive patients with 170 intracranial VBDAs, which were treated by SAC, were recruited from four high-volume centers. We used multivariate logistic regression to examine factors that affected recurrence of VBDAs. The mean duration of clinical follow-up of the 168 patients was 7.81 months (range, 3-24 months). Of the 168 patients, 4 (2.38%) suffered from intraoperative complications and 16 (9.52%) had postoperative complications. Two (1.19%) had severe disability. Imaging follow-up was available for 168 patients (170 VBDAs), with a mean duration 7.81 months, and 24 (14.12%) cases of recurrence of aneurysms were noted. Aneurysm size and metal coverage of stent(s) at the neck were independent predictors of recurrence after SAC by logistic regression analysis. This multicenter cohort study shows that aneurysm size and the metal coverage of stent(s) at aneurysmal neck are independent factors associated with recurrence of VBDAs after SAC.

Quantitative Analysis of Intracranial Vertebrobasilar Dissecting Aneurysm with Intramural Hematoma After Endovascular Treatment Using 3-T High-Resolution Magnetic Resonance Imaging.

Quantitative measurements of intracranial vessel walls are reliable in 3-T high-resolution magnetic resonance imaging (HR-MRI). However, few reports have assessed the arterial wall after endovascular treatment (EVT) by 3-T HR-MRI. This study aimed to quantitatively analyze vessel walls in vertebrobasilar artery dissecting aneurysms after EVT. From May 2012 to December 2015, a total of 21 patients with 21 intracranial vertebrobasilar dissecting aneurysms (VBDAs) were enrolled in this consecutive study. All the VBDAs were characterized by intramural hematomas (IMHs ≥5 mm) and treated with reconstructive EVT. Images of preoperative and follow-up 3-T HR-MRI were used to evaluate the arterial wall. The relative signal intensity (RSI) of IMHs was quantified on T1-weighted imaging (T1WI) and magnetization-prepared rapid acquisition gradient-echo (MPRAGE). Angiographic follow-up was performed for a mean of 9.19 ± 3.22 months. According to angiographic results at follow-up, 21 patients were divided into 2 groups (progressive group, n= 6; stable group, n= 15). In the progressive group, RSI of IMHs was significantly increased on MPRAGE of follow-up 3-T HR-MRI compared with that before treatment (P < 0.05), and the difference was not significant on T1WI. However, in the stable group, RSI of IMHs was significantly reduced after treatment (P < 0.05). Persistent high signal intensity of IMHs in VBDAs after reconstructive EVT may be associated with the progression of VBDAs. It may also indicate an unsteady state of the aneurysm, which suggests that reconstruction of the parent artery is not satisfactory.

Epidemiology and cerebrovascular events related to cervical and intracranial arteries dissection: the experience of the city of Pisa.

Spontaneous dissection of cervical arteries (sCAD) is a major cause of ischemic stroke in young patients, with an incidence varying from 1.7 to 3/100,000/year for extracranial internal carotid artery (ICAD) and 1 to 1.9/100,000/year for extracranial vertebral artery (VAD). Reliable epidemiological data on stroke incidence related to sCAD are scarce in Italy. This study aims to evaluate the incidence, clinical features, and outcome of cerebrovascular events related to sCAD and spontaneous intracranial arteries dissections (sIAD) in the city of Pisa (Italy). We retrospectively analyzed consecutive patients admitted between December 1997 and June 2015 with a diagnosis of stroke, TIA, or Bernard-Horner syndrome due to acute cervical or intracranial artery dissection. Considering that our hospital collects presumptively all patients hospitalized with sCAD coming from the referral geographical area, data may provide a good approximation to real incidence of sCAD in our population. Clinical and radiological features, acute treatment and outcome were collected. Seventy-seven cases were included (mean age 48.1±10.4years, range 23-77,72.7% males), 66 residents in the district of Pisa. Crude incidence rate of cerebrovascular events due to intra or extracranial dissection was 1.88/100,000/year. The incidence of ICAD was 0.80/100,000/year and 0.43/100,000/year for VAD. Stroke occurred in 76.6% of patients. VAD was more prone to cause ischemic stroke and present with cervical pain or focal signs (p<0.01) than ICAD group, which had older age at onset. sIAD were more frequent in the posterior circle (p=0.01) and more associated with ischemic lesions. A good outcome (mRS 0-2) was observed in 79% of patients. This is the first epidemiological attempt to investigate impact of sCAD and sIAD in Italy.

Simultaneous Onset of Ischemic and Hemorrhagic Stroke Due To Intracranial Artery Dissection

Intracranial dissections commonly present as ischemic stroke and as hemorrhagic stroke. In general, while either ischemic stroke or hemorrhagic stroke may develop, the simultaneous onset of both may also occasionally occur. In this report, we present a case of simultaneous development of ischemic stroke and hemorrhagic stroke due to an intracranial artery dissection.

Treatment for Spontaneous Intracranial Dissecting Aneurysms in Childhood: A Retrospective Study of 26 Cases.

This study aimed to assess the clinicoradiological features and treatment outcomes of intracranial dissecting aneurysms (IDAs) in childhood. We conducted a retrospective study of pediatric patients who were treated for spontaneous IDAs in our institute between January 2010 and December 2015. The clinical presentation, aneurysm characteristics, treatment modality, and outcome were studied. We studied 26 pediatric patients (mean age, 13.4 years; range, 4-18 years) with 31 IDAs who comprised 6.9% of all IDA patients treated during the same period. Seventeen (65.4%) patients were males, and nine (34.6%) were females. The incidence of large (≥10 mm in size) or giant aneurysms (≥25 mm in size) was 65.5%. Twenty-one (80.8%) patients underwent endovascular or surgical treatment and five (19.2%) received conservative treatment. Perioperative complications occurred in three patients, in whom two eventually recovered completely with a Glasgow Outcome Scale (GOS) score of 5 and one partially recovered with a GOS score 4. Overall, 25 (96.2%) patients had a favorable outcome and one (3.8%) had an unfavorable outcome at a mean follow-up of 22.8 months (range, 6-60 months). Pediatric IDAs are rare. In this series, endovascular management was a relatively safe and effective method of treatment for pediatric IDAs. However, continued follow-up is required because of the possibility of aneurysm recurrence and de novo aneurysm formation after treatment.

Endovascular Treatment of Spontaneous Intracranial Fusiform and Dissecting Aneurysms: Outcomes Related to Imaging Classification of 309 Cases

To propose a modified classification system for spontaneous intracranial dissecting aneurysms (IDAs) that can guide treatment decisions. Between January 2010 and December 2015, 3183 consecutive patients were referred to our department for endovascular treatment of a cerebral aneurysm. Among this group, 309 patients harboring a total of 323 spontaneous IDAs were identified. Based on a modified imaging classification system, spontaneous IDAs were classified into 4 subtypes: classic dissecting aneurysm, segmental ectasia, dolichoectatic dissecting aneurysm, and large mural bleeding ectasia. A logistic regression analysis was conducted to identify predictors of clinical outcomes. Of the 323 IDAs, 216 (66.87%) were treated with stent-assisted coiling, 47 (14.55%) with internal trapping, and 60 (18.58%) with sole stenting. Of the 309 patients, 8 (2.59%) suffered intraoperative complications, 40 (12.94%) experienced postoperative complications, 9 died (2.79%), and 1 (0.32%) had severe disability. The mean duration of clinical follow-up of the 309 patients was 10.40 months (range, 3-72 months). Imaging follow-up was available for 262 patients (274 IDAs), with a mean duration of 7.10 months (range, 3-60 months), and 24 aneurysm recurrences (9.16%) were noted. Aneurysm type was the sole independent predictor of different outcomes on logistic regression analysis (P= 0.004). There was a strong relationship between the subtypes of spontaneous IDAs and clinical course. Our classification system is confirmed to be helpful in assessing patients' prognosis and guiding their treatment.

Ischemic stroke in young adults

The authors have analyzed the causes of ischemic stroke (IS) in more than 600 young patients examined in the cerebrovascular department of the Neurological Research Center (Moscow) during the period 2003-2016 years. It has been suggested that a wider use of high-resolution MRI and T1 weighted db-fs images as well as intracranial CTA will help to verify more often intracranial dissection and primary cerebral vasculitis that will result in a decrease of cryptogenic IS frequency.

State-of-Art Surgical Treatment of Dissecting Anterior Circulation Intracranial Aneurysms.

Intracranial dissecting aneurysms (IDAs) are an important cause of subarachnoid hemorrhage, stroke, or compression of intracranial structures. Since the availability of endovascular treatment and the advantage of intraprocedural anticoagulation, an endovascular strategy has become the mainstay of their therapy. But in some cases selective aneurysm obliteration by the endovascular approach is impossible or associated with an unacceptable risk of morbidity. This is particularly true when the IDA is a blood blister-like aneurysm or when dissection affects peripheral branches of the internal carotid artery. The literature dealing with surgical treatment of IDAs in the anterior circulation is heterogeneous, and formulation of general recommendations concerning the surgical strategy remains difficult. The aim of this study was to conduct a systematic review of the current knowledge on incidence, pathogenesis, clinical presentation, and diagnostic procedures with a special emphasis on the surgical treatment of intracranial dissections of anterior circulation.

Neurovascular manifestations of connective-tissue diseases: A review.

Patients with connective tissue diseases are thought to be at a higher risk for a number of cerebrovascular diseases such as intracranial aneurysms, dissections, and acute ischemic strokes. In this report, we aim to understand the prevalence and occurrences of such neurovascular manifestations in four heritable connective tissue disorders: Marfan syndrome, Ehlers-Danlos syndrome, Neurofibromatosis Type 1, and Loeys-Dietz syndrome. We discuss the fact that although there are various case studies reporting neurovascular findings in these connective tissue diseases, there is a general lack of case-control and prospective studies investigating the true prevalence of these findings in these patient populations. Furthermore, the differences observed in the manifestations and histology of such disease pathologies encourages future multi-center registries and studies in better characterizing the pathophysiology, prevalence, and ideal treatment options of neurovascular lesions in patents with connective tissue diseases.

Intravascular Ultrasound for Intracranial and Extracranial Carotid Artery Stent Placement

Intravascular ultrasound (IVUS) can provide valuable information regarding endoluminal morphology. We present the first description of IVUS-guided intracranial and extracranial carotid artery stent placement for arterial dissection. A 41-year-old female with a sudden-onset headache and blurred vision underwent a computed tomography (CT) angiogram imaging that revealed bilateral carotid artery dissections (BCAD) and a left vertebral artery dissection (VAD). Endovascular treatment (EVT) of a long segment right carotid artery dissection (CAD) was performed employing two Carotid WALLSTENT™ Monorails™ (8 x 36 mm, 10 x 31 mm) (Boston Scientific, Marlborough, MA). With the help of the IVUS, the distal stent was placed up to the petrous carotid artery, followed by the placement of the second stent in the immediate proximal location with some overlap that extended down to the carotid artery bulb. Intraoperative angiography and post-stenting IVUS revealed excellent stent placement with good resolution of the dissection and good luminal patency with pseudolumen obliteration. Stent use for intracranial circulation dissections will continue to be a favorable option given the decreased morbidity of endovascular therapy in this location. As endovascular surgeons become more facile with the use of IVUS, using it as a guide for stent placement and post-stenting confirmation will help them to ensure proper positioning and improved patency rates.

State-of-art in surgical treatment of dissecting posterior circulation intracranial aneurysms.

Vertebrobasilar (VB) intracranial dissecting aneurysms (IDAs) pose difficult therapeutic issues and are especially among the most difficult to manage surgically. There are, however, some cases where selective aneurysm obliteration by endovascular approach is impossible or is associated with an unacceptable risk of morbidity. This is particularly true when the aneurysm is dissecting, giant, or has a large neck. In such cases, surgical treatment may be the only alternative. Optimal management of these lesions is therefore challenging and treatment decisions have to be made on a case-by-case basis. Ideal treatment should be a complete surgical excision of the lesion; however, this procedure might only be possible after distal and proximal vessel wall occlusion which might not be tolerated by the patient depending on the location of the aneurysm. Therefore, formulation of recommendations concerning the surgical strategy remains still difficult due to inconsistency of surgical outcomes. The literature describing surgical strategy of VB IDAs is varying in quality and content, and many studies deal with only a few patients. In the presented review, the authors summarize the current knowledge on the incidence, pathogenesis, clinical presentation, and diagnostic procedures with special emphasis on surgical treatment of IDAs in posterior circulation.

Endovascular management of a complex intracranial internal carotid artery dissection in an adolescent

Abstract Background Blunt cerebrovascular injury is an important cause of morbidity and mortality following head trauma. Intracranial vessel dissections, carotid-cavernous fistulae, and pseudo-aneurysms are uncommon traumatic vascular lesions with limited evidence to guide endovascular management. Case description We describe the case of a sixteen year old male patient suffering a traumatic paraclinoidal internal carotid artery (ICA) dissection with carotid-cavernous fistula and ophthalmic artery pseudo-aneurysm. Repeat angiography demonstrated worsening dissection prompting an endovascular parent vessel sacrifice following a passed balloon test occlusion. Relevant imaging is included. Conclusions Amongst new and developing stenting technologies as well as complex surgical solutions, utilizing a modern endovascular adaptation of simple Hunterian ligation to treat a complex multi-pronged pathology may in some cases represent the best available option. Given the limited published literature, our diagnostic and treatment approach may be informative to clinicians as well as inform an evidence based management approach in similar complex intracranial vascular injuries.

The clinical and imaging features of 118 patients with spontaneous cerebral arterial dissections presenting with ischemic stroke

To investigate the clinical and radiologic features of patients with spontaneous cerebral arterial dissections (CADs) presenting with ischemic stroke and to explore the effect of gender and age on those features. Patients admitted to our stroke center diagnosed as ischemic stroke secondary to CADs from August 2008 to April 2015 were prospectively registered. Patients aged between 15 to 80 years old, who had acute brain infarcts within the territory of a major cerebral artery affected by a dissection confirmed by the neuroradiological examinations, were enrolled in the study. The followings were the exclusion criteria: (1) there were any potential causes for the brain infarcts other than CADs; (2) CADs were the results of a definite cause; (3) the clinical data were incomplete. A total of 118 patients were enrolled in the study with the mean age of (44.2±12.8) years old. There were 87 men (73.7%) and 67 patients (56.8%) aged under 45 years old. Smoking (41.5%), hypertension (25.4%) and hypercholesterolemia (21.2%) were the three leading risk factors for stroke. Hypercholesterolemia was more common in the male patients (25.3% vs 9.7%, P=0.021), whereas hypertension (39.2% vs 14.9%, P=0.005) and diabetes (25.5% vs 4.5%, P=0.002) were more common in the patients aged 45 years or older. Headache or neck pain before or at the onset of stroke was more common in the female patients (67.7% vs 34.5%, P=0.002). A total of 71 patients were found with CADs of the anterior circulation, while 47 patients with that of the posterior circulation. The involvement of the intra and extracranial arteries were documented in 59 and 59 patients, respectively. The middle cerebral artery (MCA) was the most common site in the intracranial dissection and more MCA dissections were observed in the male patients (46.3% vs 11.1%, P=0.016). The dissection of intracranial carotid artery was more common in patients aged under 45 years old (38.7% vs 0, P<0.001). Lumen status of CADs often presented as stenosis (43.2%) and occlusion (41.2%), while less aneurysm (5.9%) and aneurysm with stenosis (9.3%) were observed. Aneurysm was found to be more common in patients aged 45 years or older (11.8% vs 1.5%, P=0.042). Chinese patients with spontaneous CADs presenting with ischemic stroke have unique clinical and imaging features, which correlated with age and gender.

Surgical treatment of unruptured dissecting intracranial aneurysms of vertebral-posterior inferior cerebellar artery region.

A lack of published surgical experience and higher symptomatic recurrence than previously recognized prompted the authors to present their experience with the surgical treatment of unruptured intracranial dissecting aneurysms (UIDAs). Hospital records, neuroimaging studies, operative reports, and follow-up records were retrospectively reviewed. All patients underwent surgical exploration of the lesion with proximal clipping of the parent artery through a far-lateral suboccipital craniotomy with or without partial condylar resection. The surgical treatment of vertebral artery-posterior inferior cerebellar artery UIDAs has acceptable risk regarding perioperative mortality and morbidity. The incidence of aneurysmal recurrence or the need for retreatment seems to be less than that associated with anticoagulation/antiplatelet therapy or endovascular treatment.

Arterial Tortuosity: An Imaging Biomarker of Childhood Stroke Pathogenesis?

Arteriopathy is the leading cause of childhood arterial ischemic stroke. Mechanisms are poorly understood but may include inherent abnormalities of arterial structure. Extracranial dissection is associated with connective tissue disorders in adult stroke. Focal cerebral arteriopathy is a common syndrome where pathophysiology is unknown but may include intracranial dissection or transient cerebral arteriopathy. We aimed to quantify cerebral arterial tortuosity in childhood arterial ischemic stroke, hypothesizing increased tortuosity in dissection. Children (1 month to 18 years) with arterial ischemic stroke were recruited within the Vascular Effects of Infection in Pediatric Stroke (VIPS) study with controls from the Calgary Pediatric Stroke Program. Objective, multi-investigator review defined diagnostic categories. A validated imaging software method calculated the mean arterial tortuosity of the major cerebral arteries using 3-dimensional time-of-flight magnetic resonance angiographic source images. Tortuosity of unaffected vessels was compared between children with dissection, transient cerebral arteriopathy, meningitis, moyamoya, cardioembolic strokes, and controls (ANOVA and post hoc Tukey). Trauma-related versus spontaneous dissection was compared (Student t test). One hundred fifteen children were studied (median, 6.8 years; 43% women). Age and sex were similar across groups. Tortuosity means and variances were consistent with validation studies. Tortuosity in controls (1.346±0.074; n=15) was comparable with moyamoya (1.324±0.038; n=15; P=0.998), meningitis (1.348±0.052; n=11; P=0.989), and cardioembolic (1.379±0.056; n=27; P=0.190) cases. Tortuosity was higher in both extracranial dissection (1.404±0.084; n=22; P=0.021) and transient cerebral arteriopathy (1.390±0.040; n=27; P=0.001) children. Tortuosity was not different between traumatic versus spontaneous dissections (P=0.70). In children with dissection and transient cerebral arteriopathy, cerebral arteries demonstrate increased tortuosity. Quantified arterial tortuosity may represent a clinically relevant imaging biomarker of vascular biology in pediatric stroke.