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The underlying cause of hemorrhage in this patient was (B) Axial T2/FLAIR MRI sequence showing non-traumatic SAH visible as hyperintense signal within the cerebra right frontal lobe (arrows). (C) Axial head CT with isolated IVH in the third (C, left panel) and fourth (C, right panel) ventricles (arrows) ass hydrocephalus. (D) Axial (D, left panel) and sagittal (D, right panel) T1-weighted MRI sequence demonstrating a large right fro (arrows) with intraventricular extension into the entire right lateral ventricle (arrowheads). CT: computed tomography; IPH: intraparenchymal hemorrhage; FLAIR: fluid-attenuated inversion recovery; M resonance image; SAH: subarachnoid hemorrhage; IVH: intraventricular hemorrhage. Graphic 108187 Version 1.0 https://www.uptodate.com/contents/hemorrhagic-stroke-in-children/print 28/33 7/7/23, 11:29 AM Hemorrhagic stroke in children - UpToDate Hemorrhagic stroke etiologies (A) Lateral view of conventional cerebral angiogram demonstrating an extensive left parieto-occipital AVM (ar vessels from the left posterior cerebral, middle cerebral, and anterior cerebral arteries with early deep and su veins. (B) Axial T2/FLAIR (B, left panel) and susceptibility-weighted (B, right panel) MRI sequences showing a left fro malformation (arrows) with calcified components within the lesion (hyperintense punctate signals in (B, left p susceptibility (B, right panel) consistent with blood products. (C) Coronal views of a CT angiography (C, left panel) and conventional cerebral angiogram (C, right panel) dem irregular fusiform lobulated aneurysm of the mid-basilar artery (arrowheads). (D) Sagittal (D, left panel) and axial (D, right panel) T2/FLAIR-weighted MRI sequence of a patient with a large (arrowheads) with associated IVH from a posterior fossa primitive neuroectodermal tumor. AVM: arteriovenous malformation; CT: computed tomography; IPH: intraparenchymal hemorrhage; FLAIR: flu inversion recovery; MRI: magnetic resonance image; IVH: intraventricular hemorrhage. Graphic 108188 Version 1.0 https://www.uptodate.com/contents/hemorrhagic-stroke-in-children/print 29/33 7/7/23, 11:29 AM Hemorrhagic stroke in children - UpToDate Differential diagnosis of hemorrhagic stroke in children Arterial ischemic stroke with or without hemorrhagic transformation Bell's palsy Brain tumor Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) Cerebral infections including abscess, encephalitis, and meningitis Cerebral sinovenous thrombosis with or without venous infarction or hemorrhage Complications of migraine Conversion disorder Metabolic derangements such as hypoglycemia Methotrexate and other chemotherapeutic agent neurotoxicity Mitochondrial disease such as mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS) Musculoskeletal disorders Organic or amino acidurias Posterior reversible encephalopathy syndrome (PRES) Postictal (Todd) paralysis White matter diseases including multiple sclerosis, acute disseminated encephalomyelitis, and leukodystrophies Graphic 108249 Version 1.0 https://www.uptodate.com/contents/hemorrhagic-stroke-in-children/print 30/33 7/7/23, 11:29 AM Hemorrhagic stroke in children - UpToDate MRI algorithm for the diagnosis of white matter disorders https://www.uptodate.com/contents/hemorrhagic-stroke-in-children/print 31/33 7/7/23, 11:29 AM Hemorrhagic stroke in children - UpToDate MRI: magnetic resonance imaging; PNS: peripheral nervous system; CADASIL: cerebral autosomal dominant Reproduced with permission from: Schi mann R, van der Knaap MS. Invited Article: An MRI-based approach to the diagnosis of white m Graphic 65871 Version 13.0 https://www.uptodate.com/contents/hemorrhagic-stroke-in-children/print 32/33 7/7/23, 11:29 AM Hemorrhagic stroke in children - UpToDate Contributor Disclosures Evelyn K Shih, MD, PhD No relevant financial relationship(s) with ineligible companies to disclose. Lauren A Beslow, MD, MSCE No relevant financial relationship(s) with ineligible companies to disclose. Scott E Kasner, MD Grant/Research/Clinical Trial Support: Bayer [Stroke]; Bristol Meyers Squibb [Stroke]; Medtronic [Stroke]; WL Gore and Associates [Stroke]. Consultant/Advisory Boards: Abbvie [Stroke]; AstraZeneca [Stroke]; BMS [Stroke]; Diamedica [Stroke]; Medtronic [Stroke]. All of the relevant financial relationships listed have been mitigated. Douglas R Nordli, Jr, MD No relevant financial relationship(s) with ineligible companies to disclose. Richard P Goddeau, Jr, DO, FAHA No relevant financial relationship(s) with ineligible companies to disclose. Contributor disclosures are reviewed for conflicts of interest by the editorial group. When found, these are addressed by vetting through a multi-level review process, and through requirements for references to be provided to support the content. Appropriately referenced content is required of all authors and must conform to UpToDate standards of evidence. Conflict of interest policy https://www.uptodate.com/contents/hemorrhagic-stroke-in-children/print 33/33