Although CT is less sensitive than MRI for the early depiction of acute ischemic infarction, the technique is rapid, usually does not require the child to be sedated, and can be useful in evaluating for hemorrhage or in excluding other treatable pathologies [16]. CTA Head CTA can provide a useful assessment of intracranial vessels in arteriopathies and thromboembolic disease [17]. MRA Head MRA can provide information on the intracranial vasculature and is particularly helpful in noninvasive assessment of arteriopathies [17]. MRA is susceptible to flow-related artifacts that may simulate regions of stenosis, especially in the setting of turbulence that may occur with anemia at vessel branch points [26]. MRI and MRA should include the cervical vessels in cases of unexplained stroke because cerebral arterial abnormalities are found in 25% of patients [27]. CT Head Perfusion Perfusion CT in children is feasible but requires repetitive imaging of the brain [28]. MR Head Perfusion Perfusion-weighted MR can be performed with either dynamic susceptibility contrast administration or arterial spin-label techniques without IV contrast and can provide information on the adequacy of cerebral blood flow [17,19,29]. US Duplex Doppler Transcranial Using an open fontanel as an acoustic window, ultrasound (US) can be used to diagnose infarction in the neonate but MRI, as in the older child, is more definitive. US shows 68% of infarctions in the first 3 days of life and 87% within the first 2 weeks [34]. Detailed evaluation of the brain parenchyma is generally not possible with US following the closure of the fontanels, but Doppler US can be used to interrogate flow in the intracranial vessels [35]. Variant 3: Child. Clinical presentation suggestive of acute stroke, known or suspected arteriopathy, or moyamoya. Not a candidate for emergent treatment. Initial imaging.
Cerebrovascular Disease Child PCAs. Although CT is less sensitive than MRI for the early depiction of acute ischemic infarction, the technique is rapid, usually does not require the child to be sedated, and can be useful in evaluating for hemorrhage or in excluding other treatable pathologies [16]. CTA Head CTA can provide a useful assessment of intracranial vessels in arteriopathies and thromboembolic disease [17]. MRA Head MRA can provide information on the intracranial vasculature and is particularly helpful in noninvasive assessment of arteriopathies [17]. MRA is susceptible to flow-related artifacts that may simulate regions of stenosis, especially in the setting of turbulence that may occur with anemia at vessel branch points [26]. MRI and MRA should include the cervical vessels in cases of unexplained stroke because cerebral arterial abnormalities are found in 25% of patients [27]. CT Head Perfusion Perfusion CT in children is feasible but requires repetitive imaging of the brain [28]. MR Head Perfusion Perfusion-weighted MR can be performed with either dynamic susceptibility contrast administration or arterial spin-label techniques without IV contrast and can provide information on the adequacy of cerebral blood flow [17,19,29]. US Duplex Doppler Transcranial Using an open fontanel as an acoustic window, ultrasound (US) can be used to diagnose infarction in the neonate but MRI, as in the older child, is more definitive. US shows 68% of infarctions in the first 3 days of life and 87% within the first 2 weeks [34]. Detailed evaluation of the brain parenchyma is generally not possible with US following the closure of the fontanels, but Doppler US can be used to interrogate flow in the intracranial vessels [35]. Variant 3: Child. Clinical presentation suggestive of acute stroke, known or suspected arteriopathy, or moyamoya. Not a candidate for emergent treatment. Initial imaging.