DWI and perfusion-weighted MRI provide information on regions of infarction. SWI can demonstrate emboli, and increased oxygen extraction leads to prominence of the veins in infarcted regions. T1-weighted imaging with fat suppression or T2-weighted imaging may demonstrate an intramural hematoma in 76% to 91% of patients with dissection [50,52]. MRA Head and Neck MRA without or with IV contrast may be used to assess for cervicocranial artery dissection to demonstrate an intimal flap, vessel narrowing, or pseudoaneurysm formation [52,53]. Arteriography Cervicocerebral Catheter angiography remains the gold standard for the radiologic evaluation of dissection but is typically reserved for patients in whom dissection is suspected but not confirmed on noninvasive imaging [52,53]. Angiography may reveal vessel narrowing, pseudoaneurysm formation, or an intimal flap in regions of dissection and distal vessel occlusions due to emboli. US Duplex Doppler Transcranial and Carotid Artery Doppler US may be used to evaluate the cervical internal carotid arteries for dissection. The technique is of limited utility for carotid dissections at or above the skull base and in the evaluation of the vertebral arteries because of a lack of a good acoustic window [52]. Variant 5: Child. Clinical presentation suggestive of acute stroke, known or suspected central nervous system vasculitis. Initial imaging. Childhood vasculitis is as an inflammatory process only affecting the intracranial vessels and can result in stroke. It can present as childhood primary angiitis of the central nervous system or as a secondary phenomenon in systemic rheumatologic infections and neoplastic conditions [54]. Childhood primary angiitis of the central nervous system is subcategorized into large-medium vessel vasculitis (angiography positive) or small vessel (vessel abnormality too small to be demonstrated on MRA, CTA, or conventional angiography) best diagnosed by brain biopsy [55].
Cerebrovascular Disease Child PCAs. DWI and perfusion-weighted MRI provide information on regions of infarction. SWI can demonstrate emboli, and increased oxygen extraction leads to prominence of the veins in infarcted regions. T1-weighted imaging with fat suppression or T2-weighted imaging may demonstrate an intramural hematoma in 76% to 91% of patients with dissection [50,52]. MRA Head and Neck MRA without or with IV contrast may be used to assess for cervicocranial artery dissection to demonstrate an intimal flap, vessel narrowing, or pseudoaneurysm formation [52,53]. Arteriography Cervicocerebral Catheter angiography remains the gold standard for the radiologic evaluation of dissection but is typically reserved for patients in whom dissection is suspected but not confirmed on noninvasive imaging [52,53]. Angiography may reveal vessel narrowing, pseudoaneurysm formation, or an intimal flap in regions of dissection and distal vessel occlusions due to emboli. US Duplex Doppler Transcranial and Carotid Artery Doppler US may be used to evaluate the cervical internal carotid arteries for dissection. The technique is of limited utility for carotid dissections at or above the skull base and in the evaluation of the vertebral arteries because of a lack of a good acoustic window [52]. Variant 5: Child. Clinical presentation suggestive of acute stroke, known or suspected central nervous system vasculitis. Initial imaging. Childhood vasculitis is as an inflammatory process only affecting the intracranial vessels and can result in stroke. It can present as childhood primary angiitis of the central nervous system or as a secondary phenomenon in systemic rheumatologic infections and neoplastic conditions [54]. Childhood primary angiitis of the central nervous system is subcategorized into large-medium vessel vasculitis (angiography positive) or small vessel (vessel abnormality too small to be demonstrated on MRA, CTA, or conventional angiography) best diagnosed by brain biopsy [55].