Neuroimaging clinics of North America
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Neuroimaging Clin. N. Am. · Nov 2024
ReviewSpecial Considerations for Cross-Sectional Imaging in the Child with Neurovascular Disease.
Pediatric neurovascular diseases are a complex group of disorders associated with significant morbidity and mortality. Given their heterogeneous clinical manifestations, ranging from emergent presentations (eg, acute neurologic deficits) to chronic neurocognitive or developmental issues, cross-sectional imaging modalities play a key role in accurate diagnosis and direct further management. However, imaging pediatric patients is associated with logistical and technical issues. This article provides an overview of the cross-sectional findings of common pediatric neurovascular diseases and discusses the imaging techniques used for their diagnosis.
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Hemorrhagic stroke (HS) is an important cause of neurologic morbidity and mortality in children and is more common than ischemic stroke between the ages of 1 and 14 years, a notable contradistinction relative to adult stroke epidemiology. Rapid neuroimaging is of the utmost importance in making the diagnosis of HS, identifying a likely etiology, and directing acute care. Computed tomography and MR imaging with flow-sensitive MR imaging and other noninvasive vascular imaging studies play a primary role in the initial diagnostic evaluation. Catheter-directed digital subtraction angiography is critical for definitive diagnosis and treatment planning.
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Neuroimaging Clin. N. Am. · Nov 2024
ReviewCatheter-directed Cerebral and Spinal Angiography in Children.
Catheter-directed angiography (CDA) is the gold standard neuroimaging study employed in the workup of most neurovascular conditions in both adults and children. When neuroangiography was first introduced in 1927 by Egas Moniz, it was performed by direct percutaneous injection of a contrast bolus into the cervical carotid arteries without catheters. This method was associated with a high risk of serious complications. Though neuroangiography was performed in the pediatric population as early as in the 1940s, it was not until the 1950s that development of Seldinger technique and angiographic catheters enabled CDA to be performed as it is today.
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Vein of Galen malformations are the most common congenital neurovascular malformation and are a type of choroidal arteriovenous fistula involving the midline primitive choroidal venous circulation. The arteriovenous shunt zone of a VOGM may directly involve the embryonic precursor of the vein of Galen and/or its tributaries within the 3rd ventricle tela choroidea. Dural sinus malformations are characterized by dilated intracranial dural venous sinuses, some of which acquire multifocal arteriovenous shunts within the dural walls of these overgrown venous sinuses. Pial arteriovenous fistulae are high-flow shunts representing direct arterial to venous communication of pial blood vessels, with no definable nidus.