Magnetic resonance imaging in ischemic cerebrovascular accidents in children

Pediatric stroke is a distinct clinical entity, different from adult stroke, which is determined by the unique and diverse range of its etiologies. It occurs in 5–7 % of all vascular diseases, with adverse effects and high treatment and rehabilitation costs. Delay in stroke diagnosis in children is a common problem. Neuroimaging protocols play an important role in the timely diagnosis and treatment of childhood stroke and its imitations. MRI protocols should be based on the clinical scenario and neurological examination, considering the age and suspected type of infarction. Aim of the study was to investigate the potential of high-tech MRI methods to improve the recognition and treatment of ischemic stroke in children. Material and methods . A retrospective diagnostic study was performed in 99 children with ischemic stroke aged from 6 months to 18 years. Sick children were admitted to the clinic within 1 hour to 32 days from the onset of the disease, about 68 % of them – from non-specialized clinics. The time frame for MRI from the moment of the disease (the onset of headache, loss of consciousness or seizures as the first sign) was from 40 minutes to 24 hours. Results. During the study, reliable data indicating ischemic stroke were obtained in all children and its causes were established. At the same time, a number of MRI parameters were studied and their capabilities and potential in assessing acute stroke based on anatomical, microstructural, functional and metabolic data were demonstrated. Conclusions. For the primary detection of pediatric stroke, the MRI protocol must necessarily include the following parameters: T1- and T2-weighted images (T1WI, T2WI), fluid-attenuated inversion recovery (FLAIR), necessarily susceptibility-weighted imaging, or T2*-weighted images (SWI), diffusion-weighted imaging (DWI), and time-of-flight MR angiography (TOF MRA), even in a reduced MRI protocol of the brain. This allows for a reliable assessment of the neuroparenchyma, vascular patency and the volume of the stroke core and ischemic penumbra