CERVICAL ARTERIAL ABNORMALITIES IN CHILDHOOD ARTERIAL ISCHAEMIC STROKE

Objectives: To ascertain the incidence and describe the morphology of cervical arterial abnormalities in a consecutive series of children with arterial ischaemic stroke (AIS).

Methods: All imaging studies of children with acute, radiologically confirmed AIS presenting to our centre between 2002–2005 were reviewed by two neuroradiologists. Data was collected on demographic features, risk factors for AIS, location of cerebral infarction and presence and morphology of any intra- or extracranial arterial abnormalities on imaging. Radiological criteria for a diagnosis of definite arterial dissection were predefined as cases where there was clear intramural thrombus, an intimal flap or double lumen; cases with tapering stenosis or aneurysmal dilatation were categorised as “possible dissection”.

Results: Of the 39 children with acute AIS seen in our centre during this period, 36 (age 1 month to 16 years) had had cervical arterial imaging with magnetic resonance imaging and/or magnetic resonance angiography. Six also had catheter cerebral angiography. Seven of the 36 (19.4%) had evidence of cervical arterial abnormalities. This was not predictable on the basis of clinical factors or infarct characteristics. Thirteen children of them had intracranial arterial abnormalities. Only one child had both intracranial and cervical abnormalities. Cervical arterial abnormalities included intramural thrombus, tapering stenoses, and diffuse arterial narrowing from the aortic origins. A diagnosis of definite dissection was only made in 2 children and that of possible dissection in another 2.

Conclusion: Cervical arterial abnormalities are common in children with AIS and generally occur in the absence of intracranial arteriopathy. These observations support routine imaging of the cervical, as well as the intracranial, arteries in children with acute AIS. They provide some evidence to support the recommendation in recently published clinical guidelines for childhood stroke that the vasculature should be imaged from the aortic arch to the circle of Willis. Although, according to the guidelines, arterial dissection is the main diagnosis altering clinical management, it is not always possible to make this diagnosis with complete confidence.