Cerebrovascular Disease and Stroke
Conditions and Treatments

Treating All Vascular Diseases of the Brain and Spine

The Cerebrovascular Disease and Stroke Center at Cincinnati Children’s treats all vascular diseases of the brain and spine. In many cases, our patients have complex needs, with multiple conditions that affect their health. Our team works collaboratively with other specialists at Cincinnati Children’s to ensure that each child receives comprehensive, well-coordinated care.

An aneurysm is a bulging, weak area in the wall of an artery that supplies blood to the brain. A brain aneurysm typically does not cause symptoms and often goes unnoticed. In rare cases, a brain aneurysm ruptures, immediately releasing blood and causing a hemorrhagic stroke (bleeding in the brain). In these rare instances, there is a significant risk for brain damage or death.  

An arteriovenous malformation (AVM) is a complex tangle of abnormal connections between arteries and veins that is present at birth. It can raise a person’s blood pressure, and over time can reduce blood supply to surrounding skin and tissues. AVMs can increase a person’s risk of having a stroke or brain aneurysm. 

A cavernous malformation (CVM), also called a cavernoma, cavernous angioma or cavernous hemangioma, is a condition in which clusters of blood vessels in the brain or spinal cord form abnormally, creating “caverns” filled with slow-moving blood.  Some CVMs cause no symptoms, but larger ones may cause seizures, headaches and impaired speech or vision. 

CVMs can be found anywhere in the body, and can cause significant bleeding problems in the brain or spinal cord.  These malformations also can be attached to an important “normal” vein that the brain and spinal cord need to function normally. Some CVMs can be identified by a genetic abnormality. 

An ischemic stroke occurs when a blood clot blocks a vessel that supplies blood to the brain. When a person experiences multiple ischemic strokes over time, the strokes are considered chronic. Among the conditions that can cause chronic ischemic stroke are Moyamoya disease, certain heart conditions, sickle cell disease and trauma to an artery. 

A pseudoaneurysm occurs when the vessel wall is injured and blood flow through the vessel is disrupted or even cut off.  Blood collects outside the artery and a clot (or thrombosis) forms. This condition usually is caused by some kind of trauma to the artery. In contrast, a true aneurysm usually is caused by a defect that has been present since birth, or by some kind of disease process. 

A hemorrhagic stroke occurs when a blood vessel on or in the brain bursts. This causes bleeding in the brain, which leads to swelling and pressure. A hemorrhagic stroke can cause oxygen deprivation in the brain and permanent brain injury. Common causes of a hemorrhagic stroke include aneurysm, arteriovenous malformations, brain tumors, head trauma, high blood pressure and clotting disorders, such as sickle cell disease.

Moyamoya disease is a rare but very serious condition in which one or both of the internal carotid arteries (located in the front of the neck) become narrower over time. This causes blood flow to slow down, increasing a child’s risk of developing a blood clot. Tiny blood vessels form around the blocked artery as the body attempts to restore normal blood flow. The Japanese word “moyamoya” means “puff of smoke” − which is what the tiny blood vessels look like on an imaging test. 

If left untreated, Moyamoya disease can cause multiple strokes leaving brief or permanent weakness or mental decline. 

Moyamoya syndrome is a rare occurrence in which Moyamoya disease and another related condition are present.  Some of these related conditions include Down syndrome, Alagille, PHACE, neurofibromatosis, cancer and sickle cell disease. Radiation therapy also can induce Moyamoya disease. 

Some vascular conditions, such as arteriovenous malformation, Moyamoya disease and stroke, can cause movement disorders. Symptoms include involuntary movements such as tremors, dystonia (sustained muscle contractions) and others. 

Stroke sometimes occurs in children who are have a heart disorder, lymphoma (cancer of the immune system and white blood cells) or other serious medical conditions. Cerebrovascular specialists work in close collaboration with other specialists to ensure that patients receive well-coordinated care that addresses all of their medically complex needs.

Sinus pericranii is a rare disorder in which veins on the outside of the scalp are abnormally connected to veins in an area of the brain called the dural sinuses. Dural sinuses play a role in blood circulation in the brain.

The most visible symptom of sinus pericranii is a swollen mass on the scalp. The condition sometimes occurs along with other medical problems, such as developmental delays and macroencephaly (an abnormally large head in infants).

The most common types of head, neck and spine tumors in children are gliomas and medulloblastomas.

Head, neck and spine tumors may be benign or malignant. The medical team “grades” these tumors to indicate how serious they are. Low-grade tumors (I and II) tend to grow slowly, and high-grade tumors (III and IV) are fast-growing, malignant and spread into healthy brain tissue. 

A pseudotumor, also called idiopathic intracranial hypertension, occurs when pressure inside the skull increases for an unknown reason. Symptoms mimic a brain tumor, but no tumor is present. Symptoms can include headaches behind the eyes, ringing in the ears, nausea, vomiting or dizziness, and others.

Vein of Galen malformation is a rare type of arteriovenous malformation (AVM) deep in the brain. It occurs when blood from cerebral arteries rushes too quickly into a large vein called the vein of Galen. The blood flows away from the brain instead of toward it. This puts pressure on the heart and lungs and can lead to heart failure or pulmonary hypertension, a type of high blood pressure that affects arteries in the lungs and in the heart. 

Vein of Galen malformation occurs during early prenatal development and often is visible on a prenatal ultrasound. It must be treated soon after birth. 

Bow hunter’s syndrome is a stroke caused by turning the head to the side in a forceful way. The motion causes pressure on the arteries in the neck, which interrupts the flow of blood. A stroke occurs when blood flow becomes blocked or the blood vessel bursts. Symptoms are the same as those of a regular stroke (dizziness, vision disturbances, trouble speaking, etc.) and usually occur on only one side of the body.