Chern Joshua,  Urbine Jaqueline,  Mallon Mea,  Kazmi Faaiza,  Malik Archana,  Poletto Erica,  Faerber Eric

Final Pr. ID: Poster #: EDU-110

Sickle cell disease is a common inherited disorder due to a structural abnormality in hemoglobin affecting the shape of the red blood cells. There are a variety of manifestations of this disease affecting a multitude of different organ systems. Some of the complications with the highest morbidity are those involving the central nervous system, and thus, the radiologist plays a pivotal role in the clinical management of these patients. It is important for the radiologist to understand the disease process, the radiologic manifestations, and the screening modalities available. Read More

Authors:  Chern Joshua , Urbine Jaqueline , Mallon Mea , Kazmi Faaiza , Malik Archana , Poletto Erica , Faerber Eric

Keywords:  Moya moya, Aneurysm, CVA, Stroke, Infarction

Mirza Eushaa,  Aziz Sumaiya,  Ajilogba Kaseem,  Delf Jonathan,  Dickinson Fiona,  Samanta Rajib,  Patel Ushma,  Swienton David,  Sharaf Ahmed

Final Pr. ID: Poster #: CR-044

Case:

We present the case of a 3 year old male patient who presented to ED with right sided weakness and facial drooling post fall with head injury. On examination, there was residual right sided weakness with poor eye contact and communicative difficulties.

Urgent CT Head revealed a focal, well defined hypo-attenuation in the left basal ganglia (Figure 1).

Subsequent MRI Head and Angiogram demonstrated an anomalous origin of the left middle cerebral artery (MCA) and lenticulostriate arteries on Time of Flight (TOF) angiographic images. The left internal cerebral artery (ICA) gives off the left posterior communicating artery which loops back on it giving off a very small MCA and forming a large, odd looking A1 anterior cerebral artery (ACA) (Figure 2). The left lenticulostriate arteries arise on the horizontal segment of the loop which forms the A1 ACA (Figure 2).

The left perforator territory demonstrates high T2/FLAIR signal with diffusion restriction involving the left putamen and upper aspect of the left caudate nucleus as seen on CT (Figure 3).

The patient was initiated on antiplatelet therapy with aspirin. He subsequently represented two months later with transient left sided weakness. Neurological examination was grossly normal apart from a slow gate.

Repeat MRI demonstrated reduction in the extent of the previous T2 signal abnormality within the left putamen consistent with expected evolution of previous infarct (Figure 4).

Dual antiplatelet therapy with the addition of clopidogrel was initiated. Subsequent clinical follow up found improvement in his verbal ability and eye contact.

Discussion:

There are numerous reported anatomical variants involving the MCA, such as a duplicated, accessory and fenestration, which are related to the embryological development of the MCA (1-3). Recently, twig-like MCA’s have been reported which are likely thought to be a secondary consequence to developmental stenosis of the proximal MCA (4). There are currently no case reports describing the anomalous distal ICA, ACA and MCA findings such as those in our case report. We hypothesise that the patient clinical symptoms are likely due to the anomalous origin and tortuosity of the lenticulostriate arteries resulting in hypoperfusion and ischaemia (5). Clinical improvement was demonstrated after initiating antiplatelet therapy. Moreover, interestingly despite the small calibre MCA there was no evidence of ischaemia within this territory. Read More

Authors:  Mirza Eushaa , Aziz Sumaiya , Ajilogba Kaseem , Delf Jonathan , Dickinson Fiona , Samanta Rajib , Patel Ushma , Swienton David , Sharaf Ahmed

Keywords:  Pediatric Neuroradiology, Pediatric Stroke

Ayvazyan Sona,  Petrosyan Lilit

Final Pr. ID: Poster #: CR-052

Pediatric stroke is a relatively rare disease, but remains one of the most common causes of death in childhood.
A higher homocysteine level raises the risk of vascular disease, including stroke.
In the setting of heavy alcohol consumption, the risk for all major types of strokes is increased, especially those of ischemic etiology.
A 17-year-old boy who had used a large amount of cigarettes and alcohol the previous evening, presented to our clinic. Upon admission, the patient’s condition was critical, with impaired consciousness. Left-sided facial nerve paresis and left-sided hemiparesis were observed. An CT examination of the brain was performed, no gross changes were found and was indicates an urgent MRI. On MRI there was irregular configuration of the dorsal posterior limb of the internal capsule and ventrolateral parts of the right thalamus, with a focus of diffusion restriction and increased MR signal intensity on T2-weighted FLAIR sequences. MR findings are consistent with an acute ischemic stroke in the territory of the right anterior choroidal artery. No neurological deficits were detected after treatment.
Alcohol intoxication and hyperhomocysteinemia are significant risk factors for ischemia.
The combination of hyperhomocysteinemia with alcohol and nicotine abuse presents an even higher and more persistent risk for ischemia. Read More

Authors:  Ayvazyan Sona , Petrosyan Lilit

Keywords:  Stroke, Acute, Brain

Krishnan Vijay,  Kandula Ashrith,  Nikam Rahul

Final Pr. ID: Poster #: EDU-049

Background:
In pediatric patients presenting with neurological deficit in emergency department, special attention should be given to identify the conditions that can mimic a stroke to avoiding unnecessary interventions. There are various pathologies in pediatric populations that can mimic stroke both clinically and radiologically. Radiologists, by identifying specific imaging patterns of classical stroke and also patterns of those stroke mimics, shall aid clinician in deciding treatment options in a timely manner.

Objectives:
In this educational poster we aims at,
1) Discussing typical imaging patterns of ischemic stroke.
2) Discussing common pathologies in pediatric age group which can mimic ischimic stroke and pose challenge to the clinicians as well as radiologists.
3) Describing various imaging findings of those stroke mimics that help to differentiate from ischemic stroke.

We discuss the imaging patterns of following pediatric stroke mimics:
- Infective pathologies, including HSV encephalitis
- Demyelinating lesions.
- Vasculitis
- Migraine.
- Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS).
- Hypoxic ischemic encephalopathy.
- Moya Moya disease.
- Posterior reversible encephalopathy syndrome.
- Drug related pathologies.
- Miscellaneous conditions.

Conclusion:
Differentiation of commonly seen stroke mimics from ischemic stroke in a timely manner helps clinician for proper management and unnecessary interventions. Read More

Authors:  Krishnan Vijay , Kandula Ashrith , Nikam Rahul

Keywords:  stroke mimics, magnetic resonance imaging

Rodríguez Garza Claudia,  Guillen Gutierrez Cinthia,  Elizondo Riojas Guillermo

Final Pr. ID: Poster #: EDU-064

Review the causes of cerebral hemorrhage in the pediatric patient based on clinical cases.

Stroke is a major cause of morbidity and mortality in children worldwide. The reported annual incidence ranges from 2.3 to 13 per 100,000 children per year in developed countries. In contrast to the adult, in children, diagnosis is not as straightforward, because when children present with acute neurological deficits, stroke is often not the first diagnosis considered by the medical providers.

Neuroimaging is essential for diagnosis and differentiation of stroke from stroke mimics that can present similarly.

Stroke in children can be ischemic or hemorrhagic, referring to the term hemorrhagic stroke as a intracerebral hemorrhage that is nontraumatic and whose most common etiology is secondary to a vascular malformation (Arteriovenous Malformation (AVM), Dural/Pial Arteriovenous Fistula (Dural AVF/Pial AVF), Cavernous Malformation, Vein of Galen Aneurysmal Malformation (VGAM), Developmental Venous Anomaly (DVA), Capillary telangiectasia, Sinus Pericranii, Aneurysms).

The most commonly used classification of vascular malformation is based on angioarchitectural and histomorphological characteristics. To differentiate these classic types, in a first step, shunting lesions have to be discerned from nonshunting lesions, as well as other features of the vascular contribution that will be evaluated by image.

We cannot forget the hemorrhage associated with coagulopathy, haematological disorders, brain tumors and cerebral sinovenous thrombosis (CSVT) which in the latter case can be found as venous infarction or hemorrhage; and other less common causes of hemorraghe in pediatrics as the intracranial aneurysms, in 15% of all pediatric aneurysms are secondary to an infection (micotic aneurysm).

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Authors:  Rodríguez Garza Claudia , Guillen Gutierrez Cinthia , Elizondo Riojas Guillermo

Keywords:  vascular malformations, hemorrhage, pediatric stroke

Utz Norbert,  Daumer Ilona,  Katoh Marcus

Final Pr. ID: Poster #: EDU-020

To present a very rare case of a pontine stroke in a 13-year-old boy with NF-2.
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Authors:  Utz Norbert , Daumer Ilona , Katoh Marcus

Keywords:  NF-2, pontine stroke, vasculopathy

Cummings Terrence,  Kadom Nadja,  Holder Chad

Final Pr. ID: Poster #: EDU-115

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. Read More

Authors:  Cummings Terrence , Kadom Nadja , Holder Chad

Keywords:  MRI, Stroke, Acute

Moum Sarah,  Cantrell Donald,  Mithal Divakar,  Lam Sandi,  Shaibani Ali

Final Pr. ID: Poster #: EDU-075

Advanced neuroimaging techniques are increasingly being used in the assessment of pediatric stroke and pediatric neurovascular disease. There is mounting evidence that noncontrast brain perfusion, contrast brain perfusion, and vessel wall imaging provide added clinical value in pediatric cerebrovascular disease. This presentation will outline the current literature and demonstrate the utility of these techniques through a pictorial case review of applications in pediatric stroke and related neurovascular pathologies. Technical guidelines and recommendations for each imaging modality will also be discussed. We aim to demonstrate a role for these techniques in pediatric diagnostic algorithms and neuroimaging protocols. Read More

Authors:  Moum Sarah , Cantrell Donald , Mithal Divakar , Lam Sandi , Shaibani Ali

Keywords:  Stroke, Neurovascular disease, Advanced neuroimaging

Frost Jamie

Final Pr. ID: Poster #: EDU-006

Congenital heart disease (CHD) is the most common type of birth defect; affecting ~1% of the births per year in the U.S. Advancements in medical and surgical treatment have markedly improved survival and even infants with complex CHD survive into adulthood. However, extracardiac complications in the newborn period can cause increased morbidity and mortality. These complications can relate to alteration in flow dynamics, treatment changes, and/or sequelae of associated syndromes (Trisomy 21, 22q deletion syndrome, Heterotaxy, PHACES). The purpose of this exhibit is to highlight extracardiac complications of CHD and to review their imaging findings. Imaging findings to be reviewed will include catheter thromboses, necrotizing enterocolitis, arterial ischemic strokes, infections, malrotation, pulmonary complications related to prematurity, prolonged intubations, and associated syndromes, and complications of extracorporeal membrane oxygenation. The goal of this exhibit is to familiarize radiologists with the multiplicity of extracardiac complications in infants with CHD and to review the common imaging findings. Read More

Authors:  Frost Jamie

Keywords:  CHD related Syndromes, Stroke