Pediatric Intracranial Emergencies (2025)-M1-CNR10-2025

Video Transcription

Video Summary

The session featured three pediatric neuroradiology talks emphasizing urgent stroke and hemorrhage diagnosis and key imaging clues. Dr. Leandro Lucato reviewed pediatric arterial ischemic stroke and how MRA patterns inform etiology and prognosis: a “pure abrupt” large-vessel occlusion suggests cardioembolism; stenosis/irregularity indicates arteriopathy (common and recurrence-prone). Examples included post-varicella focal cerebral arteriopathy (often monophasic), sickle cell–related progressive bilateral arteriopathy/Moyamoya, and strokes with normal MRA (typically smaller, better recovery, lower recurrence). He then highlighted diffusion-restriction mimics with normal MRA: pure white-matter restriction can reflect toxic leukoencephalopathy (e.g., methotrexate); pure gray-matter restriction with ASL hyperperfusion suggests metabolic/migraine-related events; a central vein sign and “fluffy,” non-territorial lesions point to demyelination (MS).<br /><br />Dr. Elke Miller presented fetal/neonatal emergencies where MRI guides delivery planning and intervention: fetal anemia can cause global ischemic “superscan” diffusion restriction or hemorrhage; blunt trauma and coagulopathies can produce subdural hemorrhage with severe parenchymal injury; surviving twins after co-twin demise risk ischemic stroke; and dural sinus malformation may cause venous hypertension, infarcts, and hydrocephalus but can be treatable (embolization).<br /><br />Dr. Anant Krishnan discussed non-traumatic pediatric intracranial hemorrhage in the ED. AVMs are the leading cause of intraparenchymal hemorrhage; CTA is useful but catheter angiography remains the gold standard, and AVMs can recur after apparent cure. Other causes include cavernous malformations, aneurysms (notably ICA terminus), venous sinus thrombosis (including deep venous thrombosis with thalamic edema and IVH), Moyamoya presenting with IVH, hemorrhagic tumors (e.g., medulloblastoma), and coagulopathies.

Keywords

pediatric arterial ischemic stroke

MRA patterns and arteriopathy

focal cerebral arteriopathy post-varicella

sickle cell disease Moyamoya

diffusion restriction mimics (toxic/metabolic/demyelination)

fetal and neonatal MRI emergencies

dural sinus malformation venous hypertension

non-traumatic pediatric intracranial hemorrhage (AVM/aneurysm/venous thrombosis)