Jornal de Neurologia Pediátrica e Medicina

Evolving Pediatric Cerebral Arteriopathy on Neuroimaging

Abstract

Mubeen F Rafay, Edward C W Leung, Martin Bunge, Daniela Iancuc, James E Strong

Background: Progressive cerebral arteriopathies are not an uncommon cause of ischemic stroke in children. The clinical and radiological distinction between various cerebral arteriopathies remains a challenge and topic of controversy for physicians.

Methods: We report an 11-year-old girl who presented with a left subcortical ischemic stroke.

Results: An 11-year-old girl presented with a progressive right hemiparesis. Her neuroimaging showed diffusion restriction and T2 signal abnormalities in the left basal ganglia with normal magnetic resonance and CT angiography. Subsequent MRA and cerebral catheter angiography at 9 days post-stroke revealed medium and large vessel stenoses of bilateral distal anterior cerebral arteries, proximal and distal segment of left middle cerebral artery, and distal left internal cerebral artery.

Conclusion: This case demonstrates the uncertainties and challenges related to ischemic stroke due to cerebral arteriopathies and the importance of early evaluation with cerebral catheter angiogram with unidentified ischemic stroke etiology and normal initial non-invasive angiography.