The diagnosis of childhood primary angiitis of the central nervous system requires an acquired neurologic deficit, angiographic or histologic features of central nervous system vasculitis, and no evidence of a systemic condition associated with the central nervous system findings. CT Head Evaluation of central nervous system vasculitis by CT is typically negative [56]. CTA Head CTA can provide a noninvasive assessment of intracranial vessels in arteriopathies as an alternative to catheter angiography in some patients but is typically negative in small-vessel vasculitis (eg, childhood primary angiitis of the central nervous system) [17]. MRI Head MRI typically shows progressive multifocal parenchymal lesions on T2-weighted imaging. Gadolinium enhancement of lesions is inconsistent. MRA Head MRA can provide a noninvasive assessment of intracranial vessels in arteriopathies as an alternative to catheter angiography in some patients but is typically negative in small vessel-vasculitis (eg, childhood primary angiitis of the central nervous system) [17]. Arteriography Cervicocerebral Catheter angiography is the most sensitive imaging method in the assessment of cerebral vasculitis but is typically negative in small-vessel vasculitis (eg, childhood primary angiitis of the central nervous system) [17]. US Duplex Doppler Transcranial Head US in not usually indicated in the evaluation of cerebral vasculitis. Variant 6: Child. Nontraumatic intraparenchymal hemorrhage (hematoma) found on CT or MRI. Unknown etiology. Next imaging study. Approximately half of all strokes beyond the perinatal period are hemorrhagic, whereas only 6.5% to 13% of strokes in adults are hemorrhagic [57,58]. Hemorrhagic strokes are associated with a variety of etiologies, including arteriovenous fistula or arteriovenous malformation (48%), brain tumors (15%), genetic or acquired coagulopathy (9%), thrombocytopenia (6%), cavernous malformation (5%), and coagulopathy and aneurysm (2%) [58].
Cerebrovascular Disease Child PCAs. The diagnosis of childhood primary angiitis of the central nervous system requires an acquired neurologic deficit, angiographic or histologic features of central nervous system vasculitis, and no evidence of a systemic condition associated with the central nervous system findings. CT Head Evaluation of central nervous system vasculitis by CT is typically negative [56]. CTA Head CTA can provide a noninvasive assessment of intracranial vessels in arteriopathies as an alternative to catheter angiography in some patients but is typically negative in small-vessel vasculitis (eg, childhood primary angiitis of the central nervous system) [17]. MRI Head MRI typically shows progressive multifocal parenchymal lesions on T2-weighted imaging. Gadolinium enhancement of lesions is inconsistent. MRA Head MRA can provide a noninvasive assessment of intracranial vessels in arteriopathies as an alternative to catheter angiography in some patients but is typically negative in small vessel-vasculitis (eg, childhood primary angiitis of the central nervous system) [17]. Arteriography Cervicocerebral Catheter angiography is the most sensitive imaging method in the assessment of cerebral vasculitis but is typically negative in small-vessel vasculitis (eg, childhood primary angiitis of the central nervous system) [17]. US Duplex Doppler Transcranial Head US in not usually indicated in the evaluation of cerebral vasculitis. Variant 6: Child. Nontraumatic intraparenchymal hemorrhage (hematoma) found on CT or MRI. Unknown etiology. Next imaging study. Approximately half of all strokes beyond the perinatal period are hemorrhagic, whereas only 6.5% to 13% of strokes in adults are hemorrhagic [57,58]. Hemorrhagic strokes are associated with a variety of etiologies, including arteriovenous fistula or arteriovenous malformation (48%), brain tumors (15%), genetic or acquired coagulopathy (9%), thrombocytopenia (6%), cavernous malformation (5%), and coagulopathy and aneurysm (2%) [58].