Cerebrovascular Disease in Children : Pathophysiology and Treatment

Abstract

  Cerebrovascular disease in children is classified by age into perinatal stroke and childhood stroke. Pathophysiologically, the condition can also be classified as arterial ischemic stroke (AIS), cerebral sinovenous thrombosis, and hemorrhage. AIS is the most common cause of perinatal stroke, while hemorrhage is the dominant pathophysiology in childhood stroke. Infants with moyamoya disease (MMD) exhibit poor outcomes and a high prevalence of cerebral infarction. Preventing cerebral infarction in infants with MMD awaiting surgery is an important priority. The internal carotid artery bifurcation is a common site of cerebral aneurysms in children. Children are also characterized by a high prevalence of giant aneurysms. Moreover, in children with new and enlarging aneurysms, comorbidities, the fusiform shape, and parent artery occlusion are significant risk factors. The hemorrhage-related mortality rates of arteriovenous malformations (AVMs) in children are higher than those in adults. The resection of AVMs in children is safe and associated with high rates of angiographically confirmed obliteration. The outcomes of stereotactic radiosurgery for AVMs in children are comparable to those in adults. Long-term post-resection follow-up imaging is necessary to promptly detect AVM recurrence in children.