Vascular causes of pediatric acute ischemic stroke: the crucial role of imaging

• Wiem Feki

  Radiology Department, Hedi Chaker University Hospital, University of Sfax, Tunisia

• Fatma Hammami

  Infectious Diseases Department, Hedi Chaker University Hospital, University of Sfax, Tunisia

• Amina Kammoun

  Radiology Department, Hedi Chaker University Hospital, University of Sfax, Tunisia

• Makram Koubaa

  Infectious Diseases Department, Hedi Chaker University Hospital, University of Sfax, Tunisia

• Zaineb Mnif

  Radiology Department, Hedi Chaker University Hospital, University of Sfax, Tunisia

Background

Acute ischemic stroke (AIS) in a pediatric patient is a rare but life-threatening medical emergency. Unlike adults, pediatric strokes result from a diverse array of etiologies, with arteriopathies and cardiac anomalies playing major roles. Given the time-sensitive nature of stroke treatment, prompt identification and rapid imaging in the emergency setting are critical to improving prognosis in pediatric patients. We aimed to enumerate the principal vascular causes of pediatric AIS and to determine the specific contribution of different imaging modalities in the etiological evaluation.

Methods

We conducted a prospective study including all children aged less than 18 years who presented with AIS between January 2020 and December 2024. The study was carried out at Hedi Chaker University Hospital in Sfax.

Results

We included 22 patients (12 boys and 10 girls). Our patients were aged between one month and 9 years. Seven patients underwent ultrasonography with Doppler, seventeen patients underwent magnetic resonance imaging and eleven patients underwent computed tomography angiography. We noted arterial dissection in 8 cases, Moyamoya disease in 8 cases, hypoplasia of the internal carotid artery in 5 cases and fibromuscular dysplasia in one case. Imaging modalities provided critical diagnostic information, with Doppler ultrasound detecting flow abnormalities in arterial dissection and hypoplasia, magnetic resonance imaging delineating vascular occlusions and stenoses, and computed tomography angiography assisting in anatomical assessment. Representative cases illustrated the spectrum of vascular pathologies and imaging findings.

Conclusion

Pediatric AIS is frequently caused by a variety of vascular disorders that require multimodal imaging for accurate diagnosis. Early recognition and targeted imaging are crucial for timely intervention and improving outcomes in this vulnerable population.

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