Chapter 57E. Stroke in Children Flashcards
Question 57E-1: What is the most common presentation of stroke in neonates? A. Apnea B. Hemiparesis C. Seizures D. Spastic diplegia
Answer 57E-1: C. Seizures are the most common presenting signs of strokes in neonates, whether the stroke is ischemic, hemorrhagic, arterial, or venous. Focal signs are often not apparent until several months ofage. (p1302)
Question 57E-2: The image is a fast spin echo MRI of a young child with leukemia who presented with headache and left hand numbness. Which is the most likely diagnosis? A. Multiple arterial emboli B. Vasculitis C. Spontaneous cortical hemorrhages D. Venous thrombosis
Answer 57E-2: D. Venous thrombosis is the most likely appearance, and this was identified on the MRV of the same patient. This image shows bilateral hemorrhagic infarctions, but the pattern of following the cortical surface would be more suggestive of venous infarctions than arterial infarctions. (p 1302)
Question 57E-3: A child with stroke has totally negative studies including MRl, MRA, transthoracic echocardiogram, and basic laboratory studies for coagulopatby. The patient has a large vessel stroke which suggested proximal embolus. Which is the next step in evaluation and management? A. Antiplatelet treatment without further studies B. Cerebral angiogram C. Transesophageal echo D. Warfarin therapy without further studies
Answer 57E-3: C. TEE can occasionally show a source for proximal emboli which would not be visualized on TIE. These findings may include PFO, valvular disease, or aortic atheroma in older patients. A bubble study is performed for the TEE and shou Id be performed for the TIE as well. (p 1308 )
Question 57E-5: The image shows the vertebrobasilar MRA of a 14-year-old male who presents with vertigo, vomiting, and ataxia. This developed after he has been wrestling with his sister.Which is the most likely cause of his symptoms? A. Cardioembolic stroke B. Lacunar infarction C. Vascular malforrnaticn D. Vertebral dissection
Answer S7E-4: E. Patients with Down syndrome are of increased risk for leukemia, moyamoya, congenital heart disease, and atlantoaxial instability, all of which predispose to stroke. (p 1302)
