Original ArticlesConventional cerebral angiography in children with ischemic stroke
Introduction
The role of conventional cerebral angiography in the investigation of the child with ischemic stroke is uncertain at present. With the increasing availability of magnetic resonance angiography (MRA), it has not been clear whether this alone is sufficient or whether there is a risk of missing significant pathologic findings requiring alternative management strategies. The aim of this study was to investigate whether there is any diagnostic or therapeutic advantage to undertaking conventional cerebral angiography if MRA is available. On the basis of this experience, the authors propose a clinical algorithm for the use of conventional cerebral angiography in the investigation of children presenting with ischemic stroke.
Section snippets
Material and methods
Children presenting with ischemic stroke to the Great Ormond Street Hospital for Children between 1985 and 1996 were eligible for inclusion if a conventional cerebral angiogram had been performed during the acute admission. Stroke was defined as an acute focal neurologic deficit of greater than 24 hours duration, with evidence of cerebral infarction on cranial computed tomography or magnetic resonance imaging (MRI). Patients with stroke in the neonatal period (less than 28 days of age) and
Results
Of a total of 128 children with ischemic stroke seen between 1985 and 1996, 69 (54%) underwent conventional cerebral angiography. Patient selection for cerebral angiography and subsequent management decisions were entirely at the discretion of the clinician in charge, without any predefined guidelines. MRA became readily available in the authors’ unit in 1994; however, the proportions of children investigated with conventional angiography before and after 1994 were similar (51% and 56%).
Of the
Discussion
This study suggests that conventional cerebral angiography has a continuing role in the identification of potentially treatable cerebrovascular abnormalities in children with ischemic stroke. These include moyamoya syndrome [1], [2], arterial dissection [3], and cerebral vasculitis [4].
MRA is a sensitive imaging modality for moyamoya syndrome, especially for the detection of large vessel stenosis and occlusion. However, collateral circulation is poorly visualized and the degree of large vessel
Acknowledgments
Drs. Ganesan and Kirkham were supported by the Wellcome Trust.
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