Purpose or Case Report: An acute stroke MRI protocol is used when a paediatric patient presents to the emergency department with stroke like symptoms. Rapid imaging is needed in order to ascertain the presence of stroke, exclude stroke mimics, the extent of the stroke, and exclude any complications, such as haemorrhage. An acute stroke protocol which consist only of a diffusion weighted sequence enables quick diagnosis and does not significantly delay treatment of the patient.
Methods & Materials: Clinical patients suspected of a stroke diagnosis under the age of 18 are examined by the ER attending using a stroke algorithm. This algorithm was developed as an interdisciplinary effort, including radiology. If the patient meets stroke criteria, the acute stroke protocol is activated. This activation interrupts the workflow of the MRI department until the patient is seen, and the exam has been completed. A diffusion-weighted MRI is completed emergently and sent to the radiologist for interpretation. If the patient does not have a stroke, the exam stops here. If the exam is positive for stroke, the exam continues with a T2 FLAIR and a 3D Time of Flight MRA, which is obtained at the discretion of the radiologist after consultation with the neurology fellow. If the patient has a history of sickle-cell disease, the protocol used includes a diffusion weighted image and a susceptibility weighted image only.
Results: During the months of September 2016 and October 2016, 9 patients underwent acute stroke protocol imaging. Of these nine cases, 3 had a history of sickle cell disease. In total, 6 cases were negative for stroke, 2 were positive, and 1 was inconclusive. This positive collaboration between emergency medicine, neurology, and radiology has enabled clinicians to rapidly respond to the needs of a paediatric patient who has had a stroke with the best course of treatment.
Conclusions: Rapid MRI protocols for stroke patients are feasible and are a minimal burden to the MRI schedule given the low frequency. Using rapid MRI allows physicians to avoid unnecessary CT imaging and radiation exposure, which is an important consideration in children.