Medical Radiology and Radiation Safety. 2023. Vol. 68. № 4
DOI: 10.33266/1024-6177-2023-68-4-69-74
M.V. Lukin, A.Yu. Efimtsev, A.A. Borshevetskaya, L.E. Galyautdinova,
V.P. Ivanov, S.V. Trusheleva, E.O. Sereda, A.M. Shchetinina, A.V. Kim
Radiation Diagnostics of Ischemic Stroke
in Pediatric Practice: an Approach in the SARS-CoV2 Pandemic
V.A. Almazov National Medical Research Centre, Saint Petersburg, Russia
Contact person: M.V. Lukin, e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
Abstract
Stroke is a condition of acute cerebrovascular accident (ACV), with neurological symptoms corresponding that last more than 24 hours. This condition can lead to severe disability, persistent disorders motor and cognitive functions, and even death of the child. The most common causes of strokes in children: aneurysms, vascular malformations, neuroinfections, rheumatological and oncological diseases. As the epidemic COVID-19 spreads, its pathogenetic mechanisms have been identified that contribute to the development of ACV, including in children. These mechanisms may also play a role in the development of ACV in the course of other acute respiratory viral infections. Technological development and increasing availability of magnetic resonance imaging (MRI) and computed tomography (CT) allows to detect strokes at the earliest stages. A comprehensive examination, including clinical, laboratory, instrumental examination data, neuroimaging techniques, is necessary for the verification and pathogenetic treatment of ACV in children and adults.
This article describes the problems of early diagnosis of childhood stroke and the features of choosing a radiological method of research. Below is a clinical case of an 11-year-old patient with a genetically determined tendency to thrombosis, who had previously suffered an acute respiratory disease, with consequences in the form of an ischemic stroke in the basin of the left middle cerebral artery - in the area of blood supply to the anterior choroidal artery.
Keywords: stroke in children, MRI, CT, COVID-19, acute respiratory disease
For citation: Lukin MV, Efimtsev AYu, Borshevetskaya AA, Galyautdinova LE, Ivanov VP, Trusheleva SV, Sereda EO, Shchetinina AM, Kim AV. Radiation Diagnostics of Ischemic Stroke in Pediatric Practice: an Approach in the SARS-CoV2 Pandemic. Medical Radiology and Radiation Safety. 2023;68(4):69–74. (In Russian). DOI:10.33266/1024-6177-2023-68-4-69-74
References
1. World Health Statistics 2021: Monitoring Health for the SDGs, Sustainable Development Goals. ISBN 978-92-4-002705-3 (Online), ISBN 978-92-4-002706-0 (Print).
2. Zmeyeva E.V., Zmeyev S.A., Lyutaya E.D. Algorithm for the Emergency Beam Diagnostics of a Stroke Under Conditions of a Modern Hospital. Vestnik VolGMU = Journal of VolgSMU. DOI 10.19163/1994-9480-2020-3(75)-112-116 (In Russ.).
3. Turney C., Wang W., Seiber E., Lo W. Acute Pediatric Stroke: Contributors to Institutional Cost. Stroke. 2011;42:11:3219-3225.
4. Fullerton H.J., Wu Y.W., Zhao S., Johnston S.C. Risk of Stroke in Children: Ethnic and Gender Disparities. Neurology. 2003;61;2:189–194. doi: 10.1212/01.wnl.0000078894.79866.95.
5. Zahuranec D.B., Brown D.L., Lisabeth L.D., Morgenstern L.B. Is It Time for a Large, Collaborative Study of Pediatric Stroke? Stroke. 2005;36;9:1825–1829.
6. Mackay M.T., Wiznitzer M., Benedict S.L., Lee K.J., Deveber G.A., Ganesan V., International Pediatric Stroke Study Group. Arterial Ischemic Stroke Risk Factors: the International Pediatric Stroke Study. Ann. Neurol. 2011;69;1:130-140. doi: 10.1002/ana.22224.
7. Liang W., Liang H., Ou L., et al. Development and Validation of a Clinical Risk Score to Predict the Occurrence of Critical Illness in Hospitalized Patients With COVID-19. JAMA Intern. Med. 2020;180;8:1081-1089. https://doi.org/10.1001/jamainternmed.2020.2033.
8. Putilina M.V., Vechorko V.I., Grishin D.V., Sidelnikova L.V. Acute Cerebrovascular Accidents Associated with Sars-Cov-2 Coronavirus Infection (Covid-19). Zhurnal Nevrologii i Psikhiatrii im. S.S. Korsakova = The Korsakov’s Journal of Neurology and Psychiatry. 2020;120;12:109–117. DOI: 10.17116/jnevro2020120121109 (In Russ.).
9. Lindan C.E., Mankad K., Ram D., Kociolek L.K., Silvera V.M., Boddaert N., Stivaros S.M., Palasis S., ASPNR PECOBIG Collaborator Group. Neuroimaging Manifestations in Children with SARS-CoV-2 Infection: a Multinational, Multicentre Collaborative Study. Lancet Child. Adolesc. Health. 2021;5;3:167–177. doi: 10.1016/S2352-4642(20)30362-X.
10. Rukhsar Shabir Osman, et al. SARS-CoV-2 Precipitating a Stroke in a Child? A Case Report from Tanzania. Pan African Medical Journal. 2022;42;33. Doi: 10.11604/pamj.2022.42.33.33018.
11. Tiwari L., Shekhar S., Bansal A., Kumar S. COVID-19 Associated Arterial Ischaemic Stroke and Multisystem Inflammatory Syndrome in Children: a Case Report. Lancet Child. Adolesc. Health. 2021;5;1:88-90. doi: 10.1016/S2352-4642(20)30314-X.
12. Zhang S., Zhang J., Wang C., Chen X., Zhao X., Jing H., Liu H., Li Z., Wang L., Shi J. COVID-19 and Ischemic Stroke: Mechanisms of Hypercoagulability (Review). Int. J. Mol. Med. 2021;47;3:21. doi: 10.3892/ijmm.2021.4854.
13. Khaytovich A.B., Ermachkova P.A. Pathogenesis of COVID-19. Tavricheskiy Mediko-Biologicheskiy Vestnik. 2020;23;4:113-132. DOI: 10.37279/2070-8092-2020-23-4-113-132 (In Russ.).
14. Powers W.J., Rabinstein A.A., Ackerson T., Adeoye O.M., Bambakidis N.C., Becker K., Biller J., Brown M., Demaerschalk B.M., Hoh B., Jauch E.C., Kidwell C.S., Leslie-Mazwi T.M., Ovbiagele B., Scott P.A., Sheth K.N., Southerland A.M., Summers D.V., Tirschwell D.L. Guidelines for the Early Management of Patients with Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2019;50;12:e344-e418. doi: 10.1161/STR.0000000000000211.
15. Muir K.W., Buchan A., von Kummer R., Rother J. Imaging of Acute Stroke. Lancet Neurol. 2006;5;9:755-768. doi: 10.1016/S1474-4422(06)70545-2.
16. Wintermark M., Rowley H.A., Lev M.H. Acute Stroke Triage to Intravenous Thrombolysis and Other Therapies with Advanced CT or MR Imaging: Pro CT. Radiology. 2009;251;3:619–626. doi: 10.1148/radiol.2513081073.
17. Köhrmann M., Schellinger P.D. Acute Stroke Triage to Intravenous Thrombolysis and Other Therapies with Advanced CT or MR Imaging: Pro MR Imaging. Radiology. 2009;251;3:627–633. doi: 10.1148/radiol.2513081074.
18. Sergeyev D.V., Lavrentyeva A.N., Krotenkova M.V. CT-Perfusion in Acute Ischemic Stroke. Annaly Klinicheskoy i Eksperimentalnoy Nevrologii = Annals of Clinical and Experimental Neurology. 2008;2;3. DOI: https://doi.org/10.17816/psaic397 (In Russ.).
19. Vilela P., Rowley H.A. Brain Ischemia: CT and MRI Techniques in Acute Ischemic Stroke. Eur. J. Radiol. 2017;96:162-172. doi: 10.1016/j.ejrad.2017.08.014.
20. Сhen J., Licht D.J., Smith S.E., Agner S.C., Mason S., Wang S., Silvestre D.W., Detre J.A., Zimmerman R.A., Ichord R.N., Wang J. Arterial Spin Labeling Perfusion MRI in Pediatric Arterial Ischemic Stroke: Initial Experiences. J. Magn. Reson. Imaging. 2009;29;2:282-290. doi: 10.1002/jmri.21641.
21. Lanni G., Catalucci A., Conti L., Di Sibio A., Paonessa A., Gallucci M. Pediatric Stroke: Clinical Findings and Radiological Approach. Stroke Res. Treat. 2011;2011:172168. doi: 10.4061/2011/172168.
22. Oppenheim C., Naggara O., Arquizan C., Brami-Zylberberg F., Mas J.L., Meder J.F., Frédy D. [MRI of Acute Ischemic Stroke]. J. Radiol. 2005;86;9 Pt 2:1069-1078 (In French.). doi: 10.1016/s0221-0363(05)81495-7.
23. Bohmer M., Niederstadt T., Heindel W., et al. Impact of Childhood Arterial Ischemic Stroke Standardized Classification and Diagnostic Evaluation Classification on Further Course of Arteriopathy and Recurrence of Childhood Stroke. Stroke. 2019;50;1:83–87. DOI: 10.1161/STROKEAHA.118.023060.
24. Beslow L.A., Linds A.B., Fox C.K., et al. International Pediatric Stroke Study Group. Pediatric Ischemic Stroke: An Infrequent Complication of SARS-CoV-2. Ann. Neurol. 2021;89;4:657–665. DOI: 10.1002/ana.25991.
25. Appavu B., Deng D., Dowling M.M., et al. Arteritis and Large Vessel Occlusive Strokes in Children after COVID-19 Infection. Pediatrics. 2021;147;3:e2020023440. DOI: 10.1542/peds.2020-023440.
26. Shchetinina A.M., Ivanov V.P., Kim A.V., Ivanova G.G., Malko V.A., Alekseyeva T.M. Ischemic Stroke in a Pediatric Patient: Complication of the Course of COVID-19 (Clinical Case and Literature Review). Russkiy Zhurnal Detskoy Nevrologii = Russian Journal of Child Neurology. 2022;17;2:47-54. https://doi.org/10.17650/2073-8803-2022-17-2-47-54 (In Russ.).
27. Kalashnikova L.A., Dobrynina L.A., Legenko M.S. Primary Central Nervous System Vasculitis. Zhurnal Nevrologii i Psikhiatrii im. S.S. Korsakova = The Korsakov’s Journal of Neurology and Psychiatry. 2019;119;8:113-123. https://doi.org/10.17116/jnevro2019119081113 (In Russ.).
PDF (RUS) Full-text article (in Russian)
Conflict of interest. The authors declare no conflict of interest.
Financing. The study had no sponsorship.
Contribution. Article was prepared with equal participation of the authors.
Article received: 20.02.2022. Accepted for publication: 27.03.2023.