Presenting symptoms of hemorrhagic stroke differ with respect to the age of the child but may include mental status changes, seizures, or focal neurologic deficit. CT Head Unenhanced head CT is useful to assess the location and size of hemorrhage, evidence of mass effect, and hydrocephalus [59]. IV contrast may be helpful in demonstrating an underlying cause for the hemorrhage, such as vascular malformation, aneurysm, or tumor. CTA Head CTA may be used to delineate the vascular anatomy and may be used to demonstrate a vascular malformation or aneurysm but lacks the temporal information available from catheter angiography. MRI Head Unenhanced MRI can delineate the location and size of hemorrhage, evidence of mass effect, and hydrocephalus and may show evidence of an underlying structural lesion, such as vascular malformation, aneurysm, or tumor. SWI and arterial spin-labeling imaging may improve the delineation of the draining veins and arteriovenous shunting, respectively, compared with conventional MR sequences [24]. Contrast may be required to demonstrate small malformations, such as those that may occur in hereditary hemorrhagic telangiectasia, or other causes of parenchymal hematoma, such as tumor. MRA Head MRA may be used to delineate the vascular anatomy and may be used to demonstrate a vascular malformation or aneurysm but lacks the temporal information available from catheter angiography. Arteriography Cervicocerebral Catheter angiography is the gold standard for imaging of high-flow vascular malformations and aneurysms [60]. Although developmental venous anomalies (DVAs) can be demonstrated on catheter angiography, cavernoma and capillary telangiectasia are angiographically occult [61]. Variant 7: Child. Nontraumatic subarachnoid hemorrhage (SAH) detected by noncontrast CT. Next imaging study. Fifty-seven percent of SAH in children is due to aneurysm; however, only 2% to 15% of hemorrhagic strokes in children are due to aneurysm [58,62].
Cerebrovascular Disease Child PCAs. Presenting symptoms of hemorrhagic stroke differ with respect to the age of the child but may include mental status changes, seizures, or focal neurologic deficit. CT Head Unenhanced head CT is useful to assess the location and size of hemorrhage, evidence of mass effect, and hydrocephalus [59]. IV contrast may be helpful in demonstrating an underlying cause for the hemorrhage, such as vascular malformation, aneurysm, or tumor. CTA Head CTA may be used to delineate the vascular anatomy and may be used to demonstrate a vascular malformation or aneurysm but lacks the temporal information available from catheter angiography. MRI Head Unenhanced MRI can delineate the location and size of hemorrhage, evidence of mass effect, and hydrocephalus and may show evidence of an underlying structural lesion, such as vascular malformation, aneurysm, or tumor. SWI and arterial spin-labeling imaging may improve the delineation of the draining veins and arteriovenous shunting, respectively, compared with conventional MR sequences [24]. Contrast may be required to demonstrate small malformations, such as those that may occur in hereditary hemorrhagic telangiectasia, or other causes of parenchymal hematoma, such as tumor. MRA Head MRA may be used to delineate the vascular anatomy and may be used to demonstrate a vascular malformation or aneurysm but lacks the temporal information available from catheter angiography. Arteriography Cervicocerebral Catheter angiography is the gold standard for imaging of high-flow vascular malformations and aneurysms [60]. Although developmental venous anomalies (DVAs) can be demonstrated on catheter angiography, cavernoma and capillary telangiectasia are angiographically occult [61]. Variant 7: Child. Nontraumatic subarachnoid hemorrhage (SAH) detected by noncontrast CT. Next imaging study. Fifty-seven percent of SAH in children is due to aneurysm; however, only 2% to 15% of hemorrhagic strokes in children are due to aneurysm [58,62].