Repeated vascular imaging findings and clinical charts of 79 children with anterior circulation arterial ischemic stroke (AIS) and unilateral intracranial arteriopathy of the internal carotid bifurcation were studied at the University Medical Center, Utrecht, The Netherlands, and other centers in France, UK, and Canada. The characteristics of 5 (6%) patients with progressive and 74 (94%) with transient cerebral arteriopathy (TCA) were compared after a median follow-up of 1.4 years. Most infarcts were localized in the basal ganglia. Follow-up vascular imaging showed complete normalization in 23% of TCA patients; 77% had residual arterial abnormalities, with improvement in 45% and stabilization in 32%. Before the arteriopathy stabilized or improved, transient worsening occurred in 14 (19%) of TCA patients; 13 (18%) had a recurrent stroke or TIA. Stroke was preceded by chickenpox in 44% of TCA patients and in none of those with progressive arteriopathies. Neurological outcome was good in 30 (41%) of the TCA patients and in none of the 5 with progressive arteriopathy. Progressive arteriopathy was associated with arterial occlusion, moyamoya disease and anterior cerebral artery involvement, and with stroke recurrence. [1]

COMMENT. In contrast to adults with stroke, the majority of childhood arterial ischemic strokes are caused by non-atherosclerotic arterial disease. Transient cerebral arteriopathy is a common cause and is characterized by infarction in the lateral lenticulostriate territory. The majority of patients in the above study had unilateral transient cerebral arteriopathy, and stroke was preceded by chickenpox (post-varicella arteriopathy) in 44%. Evidence supports a post-infectious inflammatory mechanism underlying transient cerebral arteriopathy.