Paediatric stroke and cerebral sinovenous thrombosis: Viva

Branch 1: Classification and the bedside approach

The candidate should classify paediatric stroke into arterial ischaemic stroke, cerebral sinovenous thrombosis, and haemorrhagic stroke, and state that the division matters because each form carries a distinct cause, imaging target, and treatment. A strong candidate states that this girl, with headache, papilloedema, seizures, and a recent ear infection, has the classic presentation of cerebral sinovenous thrombosis, and that the ear infection likely spread to the adjacent dural sinuses to produce a transverse or sigmoid sinus thrombosis. ^[2]

If the examiner presses on the bedside approach, the candidate should state that the first move is to assess and support the airway, breathing, and circulation, to check the bedside glucose, and to establish the time of onset. The candidate should state that the stroke alert is activated, that the paediatric neurology and radiology teams are notified, and that the urgent imaging request is for an MRI brain with diffusion-weighted imaging, MRA, and MRV, because the MRV is the sequence that will reveal the venous sinus thrombosis that a plain MRI or CT would miss. ^[9]