Urgent computed tomography angiography in paediatric stroke.
Romain C Briest, Andrew K Cheung, Tejaswi Kandula and 7 others
PMID 35661998WHAT IT FOUND
Urgent CT angiography quickly identified large vessel strokes, enabling timely endovascular therapy.
Children with atypical symptoms like seizures or vomiting were diagnosed much slower, missing treatment windows. CT angiography is a useful first step when MRI is not immediately available.
Key findings
01Urgent CT angiography accurately identified arterial abnormalities and large vessel occlusions, facilitating timely endovascular therapy in patients who would have otherwise missed the window.
02Children presenting with atypical symptoms (e.g., seizures, ataxia) had significantly longer delays to diagnosis compared to those with typical hemiparesis, reducing their eligibility for time-limited treatments.
03For patients without visible arterial abnormalities on CT angiography, initial CT imaging did not worsen long-term outcomes compared to MRI-first pathways, as these patients were largely ineligible for thrombolysis anyway.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The study was small (51 patients total), limiting the generalisability of the findings. Data collection was partly retrospective, which may introduce bias. The study used surrogate markers for clinical suspicion (time of imaging request) which may not perfectly reflect when clinicians actually suspected stroke. Radiation exposure from CTA was a concern, particularly for patients with stroke mimics who received no benefit from the scan.
Declared interests
The study was approved by the hospital's Human Research and Ethics Committee with a waiver for consent. No commercial conflicts of interest were declared.
The easy way to misread this
Do not assume CT angiography is sufficient for all paediatric strokes. It missed small-vessel strokes that required MRI for diagnosis, and atypical presentations often led to significant delays that rendered time-limited treatments impossible.