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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2021; 79(04): 321-333
DOI: 10.1590/0004-282X-ANP-2020-0105
VIEW AND REVIEW

Arteriopathy in pediatric stroke: an underestimated clinical entity

Arteriopatia em crianças com acidente vascular cerebral: uma entidade clínica subestimada
Ronaldo PIZZATTO 
1   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto de Radiologia, São Paulo SP, Brazil.
,
Lucas Lopes RESENDE 
1   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto de Radiologia, São Paulo SP, Brazil.
,
Carlos Felipe Teixeira LOBO 
1   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto de Radiologia, São Paulo SP, Brazil.
,
Yuri Costa Sarno NEVES 
1   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto de Radiologia, São Paulo SP, Brazil.
,
José Albino da PAZ 
2   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto de Pediatria, São Paulo SP, Brazil.
,
César Augusto Pinheiro Ferreira ALVES 
1   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto de Radiologia, São Paulo SP, Brazil.
,
Claudia da Costa LEITE 
1   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto de Radiologia, São Paulo SP, Brazil.
,
Leandro Tavares LUCATO 
1   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto de Radiologia, São Paulo SP, Brazil.
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ABSTRACT

Background: Pediatric arterial ischemic stroke (AIS), which was thought to be a rare disorder, is being increasingly recognized as an important cause of neurological morbidity, thanks to new advances in neuroimaging. Objective: The aim of this study was to review the main etiologies of stroke due to arteriopathy in children. Methods: Using a series of cases from our institution, we addressed its epidemiological aspects, physiopathology, imaging findings from CT, MR angiography, MR conventional sequences and MR DWI, and nuclear medicine findings. Results: Through discussion of the most recent classification for childhood AIS (Childhood AIS Standardized Classification and Diagnostic Evaluation, CASCADE), we propose a modified classification based on the anatomical site of disease, which includes vasculitis, varicella, arterial dissection, moyamoya, fibromuscular dysplasia, Takayasu's arteritis and genetic causes (such as ACTA-2 mutation, PHACE syndrome and ADA-2 deficiency). We have detailed each of these separately. Conclusions: Prompt recognition of AIS and thorough investigation for potential risk factors are crucial for a better outcome. In this scenario, neurovascular imaging plays an important role in diagnosing AIS and identifying children at high risk of recurrent stroke.

RESUMO

Introdução: O acidente vascular cerebral (AVC) pediátrico, considerado um distúrbio raro, está sendo cada vez mais reconhecido como importante causa de morbidade neurológica, graças aos novos avanços na neuroimagem. Objetivo: Revisar as principais etiologias do AVC por arteriopatia em crianças. Métodos: Utilizando-se de uma série de casos de nossa instituição, abordamos seus aspectos epidemiológicos, fisiopatológicos e de imagem na angiotomografia computadorizada e angiorressonância magnética, sequências convencionais e avançadas de ressonância magnética e medicina nuclear. Resultados: Com base na classificação mais recente de AVC na infância (Classificação Padronizada e Avaliação Diagnóstica do AVC na Infância - CASCADE) propusemos uma classificação modificada com base no local anatômico da doença, que inclui vasculite, varicela, dissecção arterial, Moyamoya, displasia fibromuscular, arterite de Takayasu e causas genéticas (como mutação ACTA-2, síndrome PHACE e deficiência de ADA-2), detalhando cada uma separadamente. Conclusões: O reconhecimento imediato do AVC na infância e a investigação minuciosa de possíveis fatores de risco são cruciais para um melhor resultado. Nesse cenário, a imagem neurovascular desempenha papel importante no diagnóstico de AVC e na identificação de crianças com alto risco de recorrência.

Keywords:

Stroke - Chickenpox - Pediatric Emergency Medicine - Vasculitis, Central Nervous System - Moyamoya Disease

Palavras-chave:

Acidente Vascular Cerebral - Varicela - Medicina de Emergência Pediátrica - Vasculite do Sistema Nervoso Central - Doença de Moyamoya

Authors’ contributions:

RP: study conception and design; acquisition of data; analysis and interpretation of data; drafting of manuscript; critical review. LLR: study conception and design; analysis and interpretation; drafting of manuscript. CFTL: study conception and design; analysis and interpretation; drafting of manuscript. YCSN: study conception and design; analysis and interpretation; drafting of manuscript. JAP: drafting of manuscript; critical review. CAPFA: drafting of manuscript; critical review. CCL: drafting of manuscript; critical review. LTL: study conception and design; analysis and interpretation; drafting of manuscript; critical review.




Publication History

Received: 15 April 2020

Accepted: 07 August 2020

Article published online:
01 June 2023

© 2021. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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