O. Belousova - Pediatric stroke. Revascularization and reconstructive surgery in children with cerebrovascular disease

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This book is about pediatric stroke. The book represents the main literary information about the etiology, pathogenesis, clinical manifestations of pediatric stroke, methods of examination and tactics of conservative and surgical treatment cerebral ischemia in children and surgical treatment of acute and chronic cerebral ischemia in children.

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Pediatric stroke

Revascularization and reconstructive surgery in children with cerebrovascular disease

Authors: Shevchenko E. V., Usachev D. Y., Belousova O. B., Lukshin V. A., Lvova O. A.

© E. V. Shevchenko, 2019

© D. Y. Usachev, 2019

© O. B. Belousova, 2019

© V. A. Lukshin, 2019

© O. A. Lvova, 2019

ISBN 978-5-4493-4265-2

Created with Ridero smart publishing system

Writing Team

Olga Benuanovna Belousova

Neurologist, Dr. Med. Sci., leading research scientist in the Clinical Vascular Neurosurgery Department of FSAI «Burdenko Neurosurgery Institute» of the Ministry of Healthcare of the Russian Federation

Anton Evgenyevich Korshunov

Neurosurgeon, Cand. Med. Sci., senior research scientist in the Clinical Pediatric Department of FSAI «Burdenko Neurosurgery Institute» of the Ministry of Healthcare of the Russian Federation

Irina Andreyevna Nagorskaya

Medical Psychologist, Cand. Psych. Sci., Medical Psychologist in the Mental Research Team of FSAI «Burdenko Neurosurgery Institute» of the Ministry of Healthcare of the Russian Federation

Vasiliy Andreyevich Lukshin

Neurosurgeon, Cand. Med. Sci., senior research scientist in the Clinical Vascular Neurosurgery Department of FSAI «Burdenko Neurosurgery Institute» of the Ministry of Healthcare of the Russian Federation

Olga Aleksandrovna Lvova

Pediatric Neurologist, Dr. Med. Sci., assistant professor in Chair of Psychiatry, FSBEI of Higher Professional Education «Urals State Medical University» of the Ministry of Healthcare of the Russian Federation, leading research scientist in the Laboratory of Brain and Neurocognitive Development of FSAEI of Higher Professional Education «Ural Federal University named after the first President of Russia B.N. Yeltsin»

Olga Borisovna Sazonova

Neurophysiologist, Cand. Med. Sci., leading research scientist in the Laboratory of Clinical Neurophysiology of FSAI «Burdenko Neurosurgery Institute» of the Ministry of Healthcare of the Russian Federation

Elena Viktorovna Shevchenko

Neurosurgeon, Cand. Med. Sci., junior research scientist in the Clinical Vascular Neurosurgery Department of FSAI «Burdenko Neurosurgery Institute» of the Ministry of Healthcare of the Russian Federation

Lyudmila Valentinovna Shishkina

Pathomorphologist, Cand. Med. Sci., Head of Laboratory of Pathomorphology in FSAI «Burdenko Neurosurgery Institute» of the Ministry of Healthcare of the Russian Federation

Dmitry Yuryevich Usachev

Neurosurgeon, Corresponding Member of the Russian Academy of Sciences, Dr. Med. Sci.,Prof., Deputy Director for Science of FSAI «Burdenko Neurosurgery Institute» of the Ministry of Healthcare of the Russian Federation

List of acronyms and conventional symbols

ABP – arterial blood pressure
ACA – anterior cerebral artery
ACVD – acute cerebrovascular disease
ADHD – attention deficiency and hyperactivity
disorder
ADP test – adenosine diphosphate induced
platelet aggregation test
AHT – arterial hypertension
ASA – acetylsalicylic acid
ASL – Arterial Spin Labeled
ASPI test – arachidonic acid induced
platelet aggregation test
BCA – brachiocephalic arteries
CAG – cerebral angiography
CCA – common carotid artery
CCVD – complete cerebrovascular disease /
complete stroke
CN – cerebral nerves
CNS – central nervous system
CO – cerebral oximetry
CPISR – Canadian Pediatric Ischemic Stroke Registry
CVD – cerebrovascular disease
CVS – cardiovascular system
DEP – dyscirculatory encephalopathy
DMB – dura mater of brain
ECA – external carotid artery
ECG – electrocardiography
EchoCG – echo-cardiography
EDAS – encephalo-duro-arterio-synangiosis
EDMS – encephalo-duro-myo-synangiosis
EEG – electro-encephalography
EICMA – extra-intracranial microvascular
anastomosis
EMS – encephalo-myo-synangiosis
ICA – internal carotid artery
INR – international normalized ratio
IS (AIS) – ischemic stroke (arterial ischemic stroke)
LBFR – linear blood flow rate
MASGS – Modified Ashworth Scale of
Grading Spasticity
MCA – middle cerebral artery
MONICA – The World Health Organization’s
Multinational Monitoring of Trends and
Determinants in Cardiovascular Disease
MRA – magnetic resonance angiography
MRI – magnetic resonance imaging
NIHSS – National Institutes of Health Stroke Scale
NSA – National Stroke Association
OA – occipital artery
PCA – posterior cerebral artery
PComA – posterior communicating artery
PET – positron emission tomography
PS – pial synangiosis
SCT AG – spiral computed angiography
SCTor CT – spiral computer tomography
STA – superficial temporal artery
TCUSDG – transcranial ultrasonic dopplerography
TIA – transitory ischemic attacks
US – ultrasonography
VBS – vertebrobasilar system
WHO – World Health Organization

Introduction

Pediatric stroke. Revascularization and

reconstructive surgery in children

Pediatric stroke is one of the most widely discussed problems in contemporary medicine. This is, primarily, associated with the fact that a cerebral vascular disease (CVD) is considerably less common in childhood than in adults, and, therefore, less known. At the same time, children, who had suffered CVD, constitute an essential group among disabled children. This determines the need for a closer study of the pediatric stroke problem, particularly, in the background of successful conservative and surgical treatment of strokes in adult population.

The spectrum of clinical manifestations of the pediatric stroke is wide enough – from mild focal and isolated general cerebral symptoms to the formation of a significant neurologic deficiency with a predisposition to recurrence with the subsequent sustained disability and a high risk of fatality. Thanks to a widespread distribution and technical improvement of neuroimaging methods, the pediatric stroke is diagnosed with the ever increasing frequency. Nevertheless, the low awareness of neurologists about the CVD problem in childhood, including the transitory ischemic attacks (TIAs), frequently leads to difficulties in diagnostics and, consequently, to delayed and insufficient medical aid. Due to the variety of reasons, clinical manifestations and the course of the pediatric stroke, selecting the patient management approach becomes difficult, especially, in neurology and brain surgery departments in small city hospitals, where medical specialists lack sufficient experience in treatment of this disease.

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