E2564. Pediatric Neuroradiology in the Emergency Setting: Beyond Trauma
  1. Won Kyu Choi; The Johns Hopkins Hospital
  2. Melike Guryildirim; The Johns Hopkins Hospital
  3. Aylin Tekes; The Johns Hopkins Hospital
Children with neurologic emergencies often present with nonspecific symptoms such as headache, altered mental status, or soft tissue swelling. Prompt imaging and intervention plays a critical role in both diagnosis and monitoring for potential complications.

Educational Goals / Teaching Points
We aim to raise awareness of multiple critical entities of pediatric nontraumatic emergency involving the head, neck, and spine. In addition, we will summarize utilization of appropriate imaging modalities and relevant findings for each diagnosis.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Neonatal strokes commonly present with non-specific symptoms such as seizures, delaying the diagnosis and increasing the risk of neurological damage. In perinatal stroke, thrombotic occlusions of large cerebral arteries may not be visible on imaging that is performed hours or days after, and magnetic resonance angiogram (MRA) is often negative. Thus, prompt multisequence MRI for early detection is critical. Todd’s paralysis is a typically post-ictal condition with symptoms concerning for stroke. It is different from a stroke, as unilateral prominence of cerebral veins on affected side on susceptibility weighted imaging without diffusion restriction is characteristic. Infectious or postinfectious autoimmune conditions are also important considerations in the pediatric population. These include acute cerebellitis, Guillain-Barré Syndrome (GBS), and atypical infections such as parechovirus infection. Acute cerebellitis is an inflammatory syndrome caused by direct infection or postinfectious autoimmune mechanisms, typically demonstrating T2/fluid attenuated inversion recovery (FLAIR) hyperintensities in cerebellar hemispheres, fourth ventricular effacement, and supratentorial hydrocephalus.

Pediatric nontraumatic neurologic emergencies often present with nonspecific symptoms, resulting in delay in diagnosis. However, prompt recognition and diagnosis are critical in preserving neurologic function and long-term outcomes. For many such conditions, understanding the indicated imaging modality and classic imaging features are instrumental in narrowing the diagnosis for a given clinical situation.