ISCHEMIC STROKE / ETIOLOGY
Focal cerebral arteriopathy (FCA)
Created 22/09/2022, last revision 02/05/2023
Introduction
- focal cerebral arteriopathy (FCA) was originally referred to as transient cerebral arteriopathy (TCA)
- TCA was defined as a monophasic disease leading to unilateral intracranial stenosis (usually the distal ICA segment, M1, or A1 segments)
- follow-up vascular imaging may reveal progression or bilateral involvement (which excludes TCA); therefore, the name TCA has been replaced by FCA
- FCA is a radiologic entity with a heterogeneous etiology; it is one of the most common causes of stroke in children (up to 50%) [Rosa, 2015]
- can be present in young adults as well [Bulder, 2012]
- FCA is associated with a high risk of recurrence (up to 25%/year) [Fullerton, 2016]
FCA (focal cerebral arteriopathy of childhood)
FCA-d (focal cerebral arteriopathy – dissection type)
FCA-i (focal cerebral arteriopathy – inflammatory type)
TCA (transient cerebral arteriopathy)
VIPS (Vascular Effects of Infection in Pediatric Stroke)
Etiology
- FCA is a syndrome with heterogeneous etiology
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Clinical presentation
- stroke/TIA
- typically, subcortical structures (basal ganglia) are affected
- occasionally, a stepwise course has been reported
Diagnostic evaluation
Imaging methods
- demonstration of the vascular lesion in a typical location (distal ICA, M1, A1) ⇒ detection of FCA
- CT+CTA
- MR+MRA (optimal for imaging parenchyma and early ischemia)
- if vasculitis is suspected, obtain black blood sequences to show wall inflammation
- if vasculitis is suspected, obtain black blood sequences to show wall inflammation
- neurosonology
- the FCA Severity Score (FCASS) can assess the extent → see here
Laboratory studies
- etiological diagnosis
- serum chemistry panel
- CBC+ coagulation tests
- inflammatory parameters (CRP, ESR, etc.)
- D-Dimers
- immunologic tests (vasculitis)
- lumbar puncture
- genetic testing (e.g. for moyamoya, ACTA2 angiopathy)
- other specific tests in DDx (e.g., Fabry, etc.)
Differential diagnosis
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