Exploring the Ethical Landscape of Pediatric Neuroendovascular Treatments.

The treatment of neurovascular disease in children continues to push clinical and innovative boundaries, carrying with them uniquely high stakes. Hemorrhage from, or occlusion of, a major cerebral blood vessel may result in devastating neurological injury or death. In children and young people, the stakes around a decision to offer or withhold treatment are even greater.

Thrombectomy Versus Medical Management for Pediatric Arterial Ischemic Stroke With Large Baseline Infarct.

Background: Multiple recent randomized trials have demonstrated the benefit of thrombectomy over medical management alone in adult patients with large vessel occlusion (LVO) stroke and large infarct on baseline imaging. Cohort studies have also identified improved functional outcomes in pediatric patients who received thrombectomy. However, the role of thrombectomy in pediatric stroke with large baseline infarct remains uncertain.

Changing Management of Focal Cerebral Arteriopathy of Childhood From 2010 to 2022.

Background: The most common cause of arterial ischemic stroke in healthy children, focal cerebral arteriopathy (FCA), can progress rapidly over days with worsening brain injury. A 2017 retrospective Swiss study of corticosteroid treatment for FCA changed practice. To assess its impact, we compared the FCA cohorts from the 2 VIPS (Vascular Effects of Infection in Pediatric Stroke) prospective cohort studies.

Predictors of neurocognitive outcome following childhood hemorrhagic stroke in the left hemisphere: A case series.

Neurocognitive deficits commonly occur following hemorrhagic stroke in childhood, yet the understanding of recovery patterns and prognostic factors remains limited. Hematoma location, lateralization, volume, and age at injury have been identified as predictors of neurocognitive outcomes. This case review aims to describe and discuss the influence of these factors on neurocognitive outcomes following hemorrhagic stroke in three pediatric cases.

Thalamic oscillatory dysrhythmia and disrupted functional connectivity in thalamocortical loops in perinatal stroke.

Periventricular venous infarction (PVI) is a subtype of perinatal stroke localized to subcortical white matter occurring before 34 weeks of gestation. An emerging body of literature has reported life-long motor impairments and compromised quality of life in patients with PVI. However, there remains a paucity of foundational knowledge regarding the underlying neurobiological mechanisms that underpin these outcomes.

Characterizing the evolution of lesion, penumbra and blood-brain barrier permeability in a photothrombotic juvenile rat stroke model using MRI and histology.

Pediatric stroke is a significant cause of childhood mortality and morbidity. The clinical research in this field bears certain limitations that do not exist in the pre-clinical setting. Experimental models of ischemic stroke show differences in lesion evolution and blood-brain barrier (BBB) permeability between adult and neonatal rats.

Hemiplegic Cerebral Palsy: Clinical Features Associated With Arterial Ischemic Stroke or Periventricular Venous Infarction.

ObjectiveWe sought to determine the clinical features of hemiplegic cerebral palsy associated with perinatal arterial ischemic stroke or periventricular venous infarction.MethodsWe studied children with hemiplegic cerebral palsy enrolled at 9 rehabilitation centers across Ontario. We compared children with underlying perinatal arterial ischemic stroke or periventricular venous infarction on clinically acquired brain imaging.

Cortical Oscillatory Activity and Motor Control in Pediatric Stroke Patients With Hemidystonia.

Dystonia is a movement disorder characterized by repetitive muscle contractions, twisting movements, and abnormal posture, affecting 20% of pediatric arterial ischemic stroke (AIS) survivors. Recent studies have reported that children with dystonia are at higher risk of cognitive deficits. The connection between impaired motor outcomes and cognitive impairment in dystonia is not fully understood; dystonia might affect motor control alone, or it could also contribute to cognitive impairment through disruptions in higher-order motor processes.

Assessing the Impact of the COVID-19 Pandemic on Childhood Arterial Ischemic Stroke: An Unanticipated Natural Experiment.

Background: The VIPS (Vascular Effects of Infection in Pediatric Stroke) II prospective cohort study aimed to better understand published findings that common acute infections, particularly respiratory viruses, can trigger childhood arterial ischemic stroke (AIS). The COVID-19 pandemic developed midway through enrollment, creating an opportunity to assess its impact.

Methods: Twenty-two sites (North America, Australia) prospectively enrolled 205 children (aged 28 days to 18 years) with AIS from December 2016 to January 2022, including 100 cases during the COVID-19 pandemic epoch, defined here as January 2020 to January 2022.

Evidence of Varicella Zoster Virus Reactivation in Children With Arterial Ischemic Stroke: Results of the VIPS II Study.

Background: Varicella zoster virus (VZV) has historically been associated with focal cerebral arteriopathy and arterial ischemic stroke (AIS) in children, and risk of AIS and myocardial infarction in adults. The VIPS (Vascular Effects of Infection in Pediatric Stroke) II study aimed to determine whether VZV remains a pediatric stroke trigger in an era of routine VZV vaccination.

Methods: This 22-center prospective cohort study enrolled 205 patients (28 days to 18 years; median, 11.

Network Localization of Pediatric Lesion-Induced Dystonia.

Objective: Dystonia is a movement disorder defined by involuntary muscle contractions leading to abnormal postures or twisting and repetitive movements. Classically dystonia has been thought of as a disorder of the basal ganglia, but newer results in idiopathic dystonia and lesion-induced dystonia in adults point to broader motor network dysfunction spanning the basal ganglia, cerebellum, premotor cortex, sensorimotor, and frontoparietal regions. It is unclear whether a similar network is shared between different etiologies of pediatric lesion-induced dystonia.

Moyamoya Across the Lifespan: Current Neurologic Care and Future Directions.

Moyamoya arteriopathy is an important cause of stroke across the lifespan, with high rates of incident and recurrent stroke in affected individuals. Although it affects adults and children globally, moyamoya is more prevalent in East Asian countries, particularly Japan and Korea. The R4810K variant of the gene, most common in Asian populations, is associated with severe, early onset, multisystem vasculopathy.

Neuromodulation for Children With Hemiparesis and Perinatal Stroke: A Randomized Clinical Trial.

Importance: Current upper-extremity therapies provide inconsistent outcomes for children with unilateral cerebral palsy. Noninvasive brain stimulation, specifically transcranial direct current stimulation, may enhance motor gains when combined with therapy.

Objective: To determine whether the addition of neurostimulation to upper-extremity therapy enhances motor function in children with perinatal stroke and unilateral cerebral palsy.

The impact of sleep restriction on cerebrovascular reactivity and cognitive outcomes in healthy adolescents: A pilot crossover trial.

Background: The underlying mechanism for the association between sleep restriction (SR) and unfavorable cognitive outcomes in children and adolescents remains unclear. This study aimed to understand the effect of 5-night experimental SR on magnetic resonance imaging (MRI) measurements of cerebrovascular reactivity (CVR) and cognitive function in adolescents.

Methods: This randomized crossover study compared two sleep conditions, SR and Control Sleep (CS) in a home setting.

Magnetic Resonance Angiography Alone Is Insufficient for Diagnosis and Surgical Planning in Children With Moyamoya.

Background: The gold standard for evaluation of the severity of moyamoya vasculopathy is the Suzuki grade determined with cerebral catheter angiography (CA). With greater use of magnetic resonance angiography (MRA) it is important to understand if MRA is truly comparable to CA.

Methods: Children with moyamoya were evaluated using the Suzuki score for CA and the modified MRA six-stage Suzuki score to describe the angiographic findings in moyamoya from initial narrowing of the distal internal carotid artery to the "puff of smoke" appearance of the lenticulostriate collaterals and finally to the disappearance of this network of collaterals.

Cerebral arteriopathies of childhood and stroke - A focus on systemic arteriopathies and pediatric fibromuscular dysplasia (FMD).

Systemic vascular involvement in children with cerebral arteriopathies is increasingly recognized and often highly morbid. Fibromuscular dysplasia (FMD) represents a cerebral arteriopathy with systemic involvement, commonly affecting the renal and carotid arteries. In adults, FMD diagnosis and classification typically relies on angiographic features, like the 'string-of-beads' appearance, following exclusion of other diseases.

Assessment of MR blood-oxygen-level-dependent (BOLD) cerebrovascular reactivity under general anesthesia in children with moyamoya.

Background: Moyamoya is a progressive, non-atherosclerotic cerebral arteriopathy that may present in childhood and currently has no cure. Early diagnosis is critical to prevent a lifelong risk of neurological morbidity. Blood-oxygen-level-dependent (BOLD) MRI cerebrovascular reactivity (CVR) imaging provides a non-invasive, in vivo measure of autoregulatory capacity and cerebrovascular reserve.

Network localization of pediatric lesion-induced dystonia.

Objective: Dystonia is a movement disorder defined by involuntary muscle contractions leading to abnormal postures or twisting and repetitive movements. Classically dystonia has been thought of as a disorder of the basal ganglia, but newer results in idiopathic dystonia and lesion-induced dystonia in adults point to broader motor network dysfunction spanning the basal ganglia, cerebellum, premotor cortex, sensorimotor, and frontoparietal regions. It is unclear whether a similar network is shared between different etiologies of pediatric lesion-induced dystonia.

Long-term clinical and radiological trajectories of craniocervical vasculopathy in children with PHACE syndrome.

Aim: To describe the rates of stroke and craniocervical vasculopathy progression in children with posterior fossa malformations, hemangioma, arterial anomalies, coarctation of the aorta/cardiac defects, and eye abnormalities (PHACE) syndrome.

Method: A single-center, retrospective natural history study of children with PHACE syndrome. Clinical and sequential neuroimaging data were reviewed to study the characteristics and progression of vasculopathy and calculate the rates of arterial ischemic stroke (AIS) and transient ischemic stroke (TIA).

Social skill and social withdrawal outcomes in children following pediatric stroke.

Pediatric stroke can result in long-term impairments across attention, functional communication and motor domains. The current paper utilized parent reports of the Behavioral Assessment System for Children 2nd Edition and the Pediatric Stroke Outcome Measure to examine children's social skills and withdrawal behavior within a pediatric stroke population. Using the Canadian Pediatric Stroke Registry at The Hospital for Sick Children, data were analyzed for 312 children with ischemic stroke.

Comprehensive whole-genome sequence analyses provide insights into the genomic architecture of cerebral palsy.

We performed whole-genome sequencing (WGS) in 327 children with cerebral palsy (CP) and their biological parents. We classified 37 of 327 (11.3%) children as having pathogenic/likely pathogenic (P/LP) variants and 58 of 327 (17.