Adam de Havenon, MD
Transient cerebral arteriopathy (TCA), also known as focal cerebral arteriopathy, is a well recognized cause of ischemic stroke in the pediatric population. It is characterized by unilateral intracranial large vessel stenosis, that typically resolves on serial imaging, quite like RCVS. Over a hundred cases have been described in the literature, but the patients were of Caucasian origin.
Je Young Yeon and colleagues describe a Korean cohort of 74 pediatric patients (<18 years old) who had acute ischemic stroke and intracranial arteriopathy. Amongst the 74, there were 29 patients with unilateral large-artery arteriopathy and 25/29 had repeat vascular imaging and cardiac or hypercoaguable etiologies excluded (by report). The radiologic outcome was reversible in 17 patients (68%), who are presumed to have TCA, progressive in 5 (20%), and stable in 3 (12%). The predictors of TCA in this cohort were beading of the affected vessel and basal ganglia infarction, while ipsilateral PCA involvement and abnormal vascular networks were predictive of progressive arteriopathy.
The data presented here is novel and of interest, mainly because Asians have higher incidences of intracranial arteriopathy in both the adult and pediatric populations (moyamoya). However, this is a very limited study. We have no informative data about the patients’ clinical course, outcome, or diagnostic workup apart from the imaging studies. We are not told what treatment was provided in the reversible versus progressive or stable groups. I would not feel comfortable prognosticating or truncating a diagnostic workup based on such small numbers and sparse data, but await future meta-analysis and larger cohorts with increased curiosity.