Mechanisms of Pediatric Cerebral Arteriopathy: An Inflammatory Debate

Abstract: Arteriopathy is the leading cause of childhood arterial ischemic stroke, but its mechanisms are poorly understood. This review explores the possible role of inflammatory mechanisms and evidence for inflammatory pathophysiology in specific pediatric cerebral arteriopathies. Pathologically proven small-vessel central nervous system vasculitis provides a definitive inflammatory model where available treatments are likely improving outcomes. In contrast, a common large-vessel arteriopathy presents many features suggestive of inflammation, but definitive proof remains elusive. Recent advances and future research directions, including biomarker, neuroimaging, and pathologic approaches and how they might address these important clinical questions, are discussed.
Source: Pediatric Neurology - Category: Neurology Authors: Tags: Review Articles Source Type: research

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We report our single-center experience with thrombectomy of LVO in a series of pediatric patients, and perform a review of the literature. METHODS: Retrospective review of consecutive pediatric thrombectomy cases between 2011 and 2018. Demographic variables, imaging data, technical aspects and clinical outcome were recorded. RESULTS: In a period of 7 years, 7 children were treated for LVO at our center. Median age was 13 (2-17), and median Ped-NIHSS was 15 (3-24), and the median ASPECTS was 8 (2-10). Five patients had cardiac disease, and 2 of them were under external cardiac assistance. Median time from ons...
Source: Interventional Neuroradiology - Category: Radiology Tags: Interv Neuroradiol Source Type: research
We report a case of a young woman with a left middle cerebral artery (MCA) ischemic stroke. The patient had history of HIV-1 infection, with periods of therapeutic non-compliance. Initial computed tomography (CT) imaging studies showed stenosis of the M1 segment of the left MCA, and magnetic resonance imaging (MRI) confirmed infarction of the MCA territory. Serial transcranial Doppler ultrasound revealed progressive occlusion of the MCA and stenosis of the left anterior cerebral artery. Systemic investigation for other causes of stroke was normal. Lumbar puncture revealed a mildly inflammatory cerebrospinal fluid, and HSV-...
Source: Journal of NeuroVirology - Category: Neurology Source Type: research
We report a unique neurologic complication of COVID-19 in a patient who had extensive cerebral small-vessel ischemic lesions resembling cerebral vasculitis in a characteristic combined imaging pattern of ischemia, hemorrhage, and punctuate postcontrast enhancement. Also, a characteristic lower extremity skin rash was present in our patient. Our observation lends support to the increasingly suspected mechanism of "endotheliitis" associated with this novel coronavirus.
Source: American Journal of Neuroradiology - Category: Radiology Authors: Tags: ADULT BRAIN Source Type: research
ConclusionHR ‐MRI is an accurate direct imaging method and has a high value for the etiological diagnosis of central nervous system vasculitis. DCE‐MRI could be an effective way to evaluate and monitor blood–brain barrier to prevent clinical ischemic stroke.
Source: Brain and Behavior - Category: Neurology Authors: Tags: ORIGINAL RESEARCH Source Type: research
Authors: Takeshita S, Ogata T, Tsugawa J, Tsuboi Y Abstract A 47-year-old woman, who was diagnosed to have systemic lupus erythematosus (SLE), was admitted because she suffered a severe ischemic stroke three weeks after experiencing a transient attack of aphasia. Diffusion-weighted MR imaging revealed high intensity at the borderzone of the middle cerebral artery (MCA), while the proximal portion of the left MCA was occluded with its vascular wall enhanced by gadolinium. Intravenous methylprednisolone and heparin were administrated without any symptomatic benefit. She developed severe right hemiparesis with aphasia...
Source: Internal Medicine - Category: Internal Medicine Tags: Intern Med Source Type: research
A 43-year-old male pet shop owner on leflunomide for seronegative rheumatoid arthritis presented locally with strange behavior and aphasia, preceded by flu-like symptoms and high fevers. Initial workup revealed cerebrospinal fluid lymphocytic pleocytosis (22 cells, 74% lymphocytes), for which he was started on empiric antimicrobial therapy. Magnetic resonance imaging of the brain revealed extensive, bilateral ischemic strokes (Figure). A transesophageal echocardiogram was negative. He was then transferred to our institution for further evaluation.
Source: The American Journal of Medicine - Category: General Medicine Authors: Tags: Clinical Communication to the Editor Source Type: research
A 43-year-old male pet shop owner on leflunomide for seronegative rheumatoid arthritis presented locally with strange behavior and aphasia, preceded by flu-like symptoms and high fevers. Initial workup revealed cerebrospinal fluid lymphocytic pleocytosis (22 cells, 74% lymphocytes), for which he was started on empiric antimicrobial therapy. A brain MRI revealed extensive, bilateral ischemic strokes (Figure 1). A transesophageal echocardiogram (TEE) was negative. He was then transferred to our institution for further evaluation.
Source: The American Journal of Medicine - Category: General Medicine Authors: Tags: Clinical Communication to the Editor Source Type: research
This article will review basic neurovascular anatomy, periprocedural management, NA technique, and tips for safe and successful outcomes. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text
Source: Seminars in Interventional Radiology - Category: Radiology Authors: Tags: Review Article Source Type: research
This article reviews current knowledge on epidemiology, risk factors and causes, diagnostic considerations, management, and prognosis of ischemic stroke in young adults (those 55 years old and younger). RECENT FINDINGS The incidence of ischemic stroke in young adults has been increasing since the 1980s, which has occurred in parallel with increasing prevalence of vascular risk factors and substance abuse among the younger population. Young adults have a considerably wider range of risk factors than older patients, including age-specific factors such as pregnancy/puerperium and oral contraceptive use. Behavioral risk fac...
Source: CONTINUUM: Lifelong Learning in Neurology - Category: Neurology Tags: REVIEW ARTICLES Source Type: research
Abstract In Brazil, rabies occurs mainly within an urban cycle, in which dogs and bats are reservoirs. This paper aims to report the occurrence of rabies in Callithrix sp. in Niter ói, Rio de Janeiro, Brazil. In June 2019 a hybrid specimen was referred for diagnosis. The Direct Fluorescent Antibody, Mouse Inoculation, and Polymerase Chain Reaction tests were positive. A phylogenetic analysis was compatible with antigenic variant 3, characteristic of Desmodus rotundus. New stu dies should be undertaken to elucidate the real role of callitrichids in the urban rabies cycle.
Source: Revista da Sociedade Brasileira de Medicina Tropical - Category: Tropical Medicine Source Type: research
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