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Chapter 51 - Physiological MR imaging techniques and pediatric stroke

from Section 8 - Pediatrics

Published online by Cambridge University Press:  05 March 2013

By
Dawn Saunders ,
W. Kling Chong  and
Vijeya Ganesan
Edited by
Jonathan H. Gillard ,
Adam D. Waldman  and
Peter B. Barker
Jonathan H. Gillard
Affiliation:
University of Cambridge
Adam D. Waldman
Affiliation:
Imperial College London
Peter B. Barker
Affiliation:
The Johns Hopkins University School of Medicine
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Summary

Introduction

Stroke is an important and under-recognized disorder in children and is one of the top 10 causes of childhood death.[1] Arterial ischemic stroke affects around 8 of 100 000 children annually. Up to a quarter of these children will have a recurrence and two-thirds have long-term disability directly attributable to stroke.[2] Many advances in the understanding of childhood stroke have arisen from the insights available from modern imaging techniques, in particular from MR imaging (MRI). The aims of conventional MRI are not only to detect the infarct but also to provide information to establish the cause of the stroke and to exclude other causes (such as tumor). Clinical applications of physiological MRI techniques (MR diffusion imaging [DWI], MR perfusion imaging, and MR spectroscopy [MRS]) in this group of patients are still largely in the research domain. This chapter will consider arterial ischemic stroke (henceforth abbreviated as stroke) in children over 1 month of age.

There are some important differences in stroke etiology between adults and children. Around half of the children affected by stroke will have another recognized medical condition, most commonly sickle cell disease (SCD) or congenital heart disease. Consequently, many children may have dual pathologies on imaging, as well as factors that may influence the interpretation of physiological MRI (e.g., chronic hypoxia or polycythemia). Rather than having a single identified etiology, the majority of children with stroke will have a combination of multiple risk factors. As well as those already mentioned, other important risk factors for stroke in children are anemia (which is found in up to 40%), prothrombotic disorders, and infections such as varicella zoster virus.[3]

Type
Chapter
Information
Clinical MR Neuroimaging
Physiological and Functional Techniques
 , pp. 784 - 805
Publisher: Cambridge University Press
Print publication year: 2009

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