Catheter angiography can be used for pretreatment evaluation and post-treatment assessment of any residual anomaly [59,71]. US Duplex Doppler Transcranial Head US with Doppler may be used to show the presence of large high-flow vascular malformations, such as vein of Galen malformation and dural arteriovenous fistula or malformation in neonates and young infants. US is useful in very young children because it can be performed without sedation or anesthesia, which may be required for MRI examinations. Variant 9: Child. Clinical presentation suggestive of acute stroke, known or suspected low-flow vascular anomaly. Initial imaging. Low-flow vascular anomalies include cavernous malformation, DVA, and capillary telangiectasia. Cavernomas are comprised of endothelial spaces containing venous blood and account for 17% of hemorrhagic stroke in children [18]. In a large series, 62% of children with cavernomas presented with hemorrhage, 35% with seizures with or without hemorrhage, and 26% had cavernomas discovered incidentally [72]. Patients with cavernoma (15%) have multiple lesions and 10% have a family history of cavernoma and may have mutations in CCM1, CCM2, and CCM3 genes [72-74]. Although 9% are associated with prior cranial irradiation [72], 86% are supratentorial and 14% infratentorial in location. Cavernomas have an annual hemorrhage rate of 3.3% to 4.5% [72,75]. DVA is an anomalous vein draining normal brain parenchyma, and 20% of DVA are associated with cavernoma [72]. Most hemorrhage in patients with DVA is believed to be due to bleeding from an associated cavernoma [61,72]. CT Head Noncontrast CT can show acute hemorrhage with cavernoma. Nonhemorrhagic cavernomas and DVA may be faintly hyperdense on noncontrast imaging [61]. IV contrast increases the conspicuity of DVA. CTA Head CTA plays a limited role in the assessment of cavernoma but may be used to demonstrate a DVA. MRI Head MRI is the imaging study of choice for cavernoma. Various stages of hemorrhage may be evident.
Cerebrovascular Disease Child PCAs. Catheter angiography can be used for pretreatment evaluation and post-treatment assessment of any residual anomaly [59,71]. US Duplex Doppler Transcranial Head US with Doppler may be used to show the presence of large high-flow vascular malformations, such as vein of Galen malformation and dural arteriovenous fistula or malformation in neonates and young infants. US is useful in very young children because it can be performed without sedation or anesthesia, which may be required for MRI examinations. Variant 9: Child. Clinical presentation suggestive of acute stroke, known or suspected low-flow vascular anomaly. Initial imaging. Low-flow vascular anomalies include cavernous malformation, DVA, and capillary telangiectasia. Cavernomas are comprised of endothelial spaces containing venous blood and account for 17% of hemorrhagic stroke in children [18]. In a large series, 62% of children with cavernomas presented with hemorrhage, 35% with seizures with or without hemorrhage, and 26% had cavernomas discovered incidentally [72]. Patients with cavernoma (15%) have multiple lesions and 10% have a family history of cavernoma and may have mutations in CCM1, CCM2, and CCM3 genes [72-74]. Although 9% are associated with prior cranial irradiation [72], 86% are supratentorial and 14% infratentorial in location. Cavernomas have an annual hemorrhage rate of 3.3% to 4.5% [72,75]. DVA is an anomalous vein draining normal brain parenchyma, and 20% of DVA are associated with cavernoma [72]. Most hemorrhage in patients with DVA is believed to be due to bleeding from an associated cavernoma [61,72]. CT Head Noncontrast CT can show acute hemorrhage with cavernoma. Nonhemorrhagic cavernomas and DVA may be faintly hyperdense on noncontrast imaging [61]. IV contrast increases the conspicuity of DVA. CTA Head CTA plays a limited role in the assessment of cavernoma but may be used to demonstrate a DVA. MRI Head MRI is the imaging study of choice for cavernoma. Various stages of hemorrhage may be evident.