Pediatric stroke can be caused by a variety of conditions including sickle cell disease, infections like varicella, cardiac diseases, moyamoya disease, cerebral venous sinus thrombosis, and vascular malformations. Diagnostic techniques like MRI, MRA, CT, and angiography are used to identify abnormalities and characterize the nature of the stroke. Common findings include lesions in the brain parenchyma that may involve gray or white matter or cross vascular territories, stenosis or occlusion of arteries, moyamoya vessels, and venous sinus thrombosis. Pediatric stroke requires identifying its underlying cause to provide appropriate treatment and management.
Its important to recognise the myelination pattern in neonates and infants. This presentation talks about the myelination pattern and imaging of white matter diseases in children.
Its important to recognise the myelination pattern in neonates and infants. This presentation talks about the myelination pattern and imaging of white matter diseases in children.
Brain tumours: Analysis of a potential brain tumors
Relative prevalence of brain tumors in children. Metastases, anaplastic astrocytoma, and glioblastoma multiforme are rare. Pilocytic astrocytoma and PNETs are more common compared to adults
Brain tumours: Analysis of a potential brain tumors
Relative prevalence of brain tumors in children. Metastases, anaplastic astrocytoma, and glioblastoma multiforme are rare. Pilocytic astrocytoma and PNETs are more common compared to adults
Although, predominantly a disease of adults, its occurrence in children (0-16 years) is not so rare as once thought due to the advent of more accurate diagnostic techniques.
intracranial hemorrhage- by KEMISA HASSEN ZAINABU IIHS_jinjaUGANDA (2).pptxHASSENZAINABUKEMISA
By the end of this we shall be able to know the following
definition.of intracranial hemorriage
Classification of intracranial hemorriage
Types of intracranial hemorriage.
Causes of intracranial hemorriage.
Signs and symptoms of intracranial hemorriage
Investigations specific management.
Complication.
Ongoing nursing care.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
Acetabularia Information For Class 9 .docxvaibhavrinwa19
Acetabularia acetabulum is a single-celled green alga that in its vegetative state is morphologically differentiated into a basal rhizoid and an axially elongated stalk, which bears whorls of branching hairs. The single diploid nucleus resides in the rhizoid.
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
2. Definition
Stroke is defined as the sudden onset of focal neurological deficit
due to occlusion of blood supply or hemorrhage in the brain
causing symptoms & signs lasting greater than 24 hours.
Although, predominantly a disease of adults, its occurrence in
children (0-16 years) is not so rare as once thought due to the
advent of more accurate diagnostic techniques.
Also, the incidence of cerebro-vascular lesions has increased in
recent years as more effective treatment for some underlying
conditions causing stroke has allowed much longer life expectancy
during which time they may have a stroke.
3. Epidemiology
• In INDIA the average annual incidence rates are reported to
be 13-33/100,000 /year.
• The reported annual incidence of cerebral infarction in
children, all over the world, varies between 1.2 per 100,000(5)
to 2.7 per 100,000.
• About 20-30% of all infants of less than 35 weeks gestational
age have intra-ventricular or germinal matrix hemorrhage.
Ischemic Stroke Following Mild Head Injury: Is it the Cause? K.S. Rana, M.K. Behera, K.M. Adhikari. Indian
Pediatrics 2006;43:994-997
Cerebrovascular Disease in Children. Dr. Subhash Kaul. Indian Pediatrics 2000;37: 159-171
4. Overview of stroke in children
Venous strokeArterial stroke
Ischemic stroke Hemorrhagic stroke
Hemorrhagic
disease of
newborn
Pediatric stroke
Ruptured brain
Arteriovenous
malformation
Cerebral venous
sinus thrombosis
due to infections,
fever, dehydration
thrombopathies
Transient arteriopathy ( Varicella)
Progressive arteriopathy- Moya Moya disease/ syndrome
Vasculitis disorders (autoimmune)
Metabolic (MELAS) Primary CNS vasculitis
Hemoglobinopathies
Cardiac disease
Infections, trauma,
anemia
5. Sickle Cell Disease
Refers to a group of genetic disorders characterized by the
production of sickle-cell hemoglobin, chronic hemolytic anemia, and
ischemic tissue injury caused by altered blood flow.
Occlusion of large and small vessels, red cell sludging, and distal field
insufficiency (border-zone infarction) have been implicated in the
pathogenesis of brain injury.
6. 14 yr male child, K/C/O sickle cell anemia, Transcranial doppler revealed Rt. MCA
narrowing.
Courtesy : Dr M. M Shroff. Hospital for Sick Children Toronto
9. Cardiac diseases
• Cardiac disorders are the most common cause of ischemic stroke
in children and account for up to 50% of strokes.
• The risk of stroke in children with congenital heart disease is
related to the abnormality, diagnostic and surgical procedures,
and associated genetic or acquired factors that predispose
children to thrombosis.
• Cardiac disorders can lead to the development of intracardiac
thrombi that may embolize to the brain or can lead to
thrombosis in cyanotic patients with anemia
10.
11.
12. Cerebral Embolism From Atrial Myxoma in Pediatric Patients. Majeed Al-Mateen, Margaret Hood, Don
Trippel, Samuel J. Insalaco, Randolph K. Otto and Kari J. Vitikainen. Pediatrics 2003;112;e162.
13. Infections
• Varicella infection has been associated with stroke in children.
•
• The prevalence of stroke among children who have chicken
pox is estimated to be between one in 6,500-15,000 children
in India.
• Varicella virus causes an acute vasculitis of the arterial wall.
14. Other infectious agents responsible for
TCA
• Parvovirus B19
• CMV
• Mycoplasma pneumoniae
• Borrelia burgdorferi
• Enterovirus
• HIV
• Helicobacter pylori.
15. • 7 yr old girl, with sudden onset of severe right sided headache, followed
by left hemiparesis & slurred speech of one day duration.
• H/o Chickenpox 2 months back.
16.
17. 13 yrs male, with history of seizures with cilinical suspicion of febrile
encephalitis.
20. Trauma
• Dissection of the extracranial and intracranial portions of the
carotid and vertebrobasilar arteries is an important risk factor
for stroke in children.
• Occlusion or narrowness of the vesselʼs lumen by the
hematoma created within the arterial wall lead to cerebral
infarction distal to the lesion.
• Narrowing of the arterial lumen for up to several centimeters
“string sign” is diagnostic. However, tapering of the lumen to
complete occlusion is more common.
21. Child Neurology: Stroke due to nontraumatic intracranial dissection in a child. Bernhard Suter and Lisa
Michael El-Hakam. Neurology. 2009;72;e100. DOI 10.1212/WNL.0b013e3181a55f52.
22. Moya Moya
• Chronic progressive arteriopathy of unknown cause and has
become one of the most common causes of pediatric stroke.
• Suzuki and Kodama classified the evolution of moyamoya disease
using angiographic findings to define six phases of the disease:
Stage 1- Narrowing of carotid fork.
Stage 2- Initiation of basal moyamoya.
Stage 3- Intensification of moyamoya
Stage 4- Minimization of moyamoya.
Stage 5- Reduction of moyamoya .
Stage 6- Disappearance of moyamoya.
23. • Stenosis/occlusion of the distal ICA
• moyamoya vessels with signal voids in the basal ganglia
• ischemia
• infarction
• atrophy, and ventriculomegaly.
• Small abnormal net-like vessels proliferate giving "puff of smoke"
appearance.
• Contrast-enhanced T1WI - marked leptomeningeal enhancement
along the cortical sulci (ivy sign).
often show contrast stagnating in slow-flowing collateral
vessels both in the brain parenchymal and over its surface.
MR imaging
24. 5 yrs male child with history of left sided focal seizures with secondary generalization
25.
26. Vasculitis
The distribution of the lesions is most commonly isolated to the
anterior circulation distribution (76%) and is frequently isolated to
the posterior circulation (16%) or involve both anterior and
posterior circulations (11%).
There is overall involvement of gray and white matter but there is a
strong tendency toward central lesions involving the basal ganglia
or lateral lenticulostriate vasculature territory.
The most frequent MRA finding is a benign appearance with
proximal involvement of the carotid termination and proximal ACA
and MCA segments.
27. Aviv R et al. AJNR Am J Neuroradiol 2006;27:192-199
34. The classic features that indicate CSVT include the
• “Dense triangle” or the “Cord sign,” which describe the
increased density over the thrombosed venous sinus in a plain
CT,
• “Empty triangle” or “Empty delta (δ) ” sign in a contrast-
enhanced CT.
DWI is a sensitive technique for detecting areas of infarction.
Parenchymal changes can be seen within minutes of injury, which
allows for early identification and intervention
35. 15 months old, Fever since 5 days, Right focal seizures, Right hemiparesis, Persistent
irritability.
36.
37. MELAS
(Mitochondrial encephalopathy with lactic acidosis and stroke-like episodes)
Caused by defects in the mitochondrial genome which is inherited
purely from the female parent.
CT brain –
• Areas of low attenuation that do not correspond to vascular
territories
• predominantly in the temporo-parietal and occipital cortices and
subjacent white matter.
38. MRI –
• Hyperintense T2 lesions predominantly in the gray and
subcortical white matter in the temporal, parietal, and
occipital lobes.
• Lesions spare the deep WM and cross vascular boundaries.
• Basal ganglia calcifications and atrophy is sometimes seen.
• MR spectroscopy- lactic acid levels are increased during the
acute phase of the disease and in chronic lesions.
39. 2 yr male child, vomited while sleeping, unconscious, head drop,
tonic posturing, admitted with respiratory arrest.
40. Vascular malformations
The common risk factors for children with hemorrhagic stroke :
• Arteriovenous malformations (AVMs)
• Aneurysms
• Cavernous malformations