Intracranial aneurysms and subarachnoid hemorrhage in children and adolescents

Abstract

Thirty-eight cases of symptomatic cerebral aneurysms or spontaneous subarachnoid hemorrhage in children and adolescents were observed from 1965 to 1984; 33 cases were treated from 1970 to date. This group represents 2.6% of the total number of patients with subarachnoid hemorrhage treated at our institute in the same period. The cause of subarachnoid hemorrhage was unknown in 7 cases; an intracranial aneurysm had ruptured in 29 cases, and was unruptured but symptomatic in 2 remaining cases. Three aneurysms were mycotic. The most frequent aneurysmal locations were the internal carotid bifurcation and the anterior communicating artery; peripheral branches of the middle cerebral artery were also a relatively common location. Four patients were 3 years of age or younger: each presented peculiar clinical features, and 3 of the 4 had middle cerebral artery aneurysms. The remaining 34 patients were all above 9 years of age. Two groups were identified: (a) in 14 patients between 10 and 15 years of age, the aneurysm was most commonly at the internal carotid bifurcation (37%), and an intracerebral hematoma was observed in 50% of these cases; (b) in 20 patients between 16 and 20 years of age, the most common aneurysmal location was the anterior communicating artery (35%), and intracerebral hematomas were rare (10% of cases). Among patients with aneurysms, 19 underwent surgical exclusion by clip, with 10% morbidity and 5% mortality; 5 patients in moribund conditions were not operated on; 5 patients were conservatively treated; in 2 patients the aneurysm had disappeared at a second angiography.(ABSTRACT TRUNCATED AT 250 WORDS)

Treatment of cerebral aneurysms in children: analysis of the Kids' Inpatient Database

“…18,19,26 Aneurysms in children are different from those in adults in several aspects; they are more common in males, with a male to female ratio of almost 3:1, and they tend to be larger, with a higher incidence of giant aneurysms in children compared with adults. [13][14][15]25 Because of the latter difference, aneurysms in children may present with nonhemorrhagic symptoms such as mass effect, headaches, focal neurological deficits, and seizures. The risk of rupture of these aneurysms varied in the literature between 22% and 100% depending on the origin, including dissection, trauma, and infection.…”

Intracranial Aneurysms in Childhood: 27-Year Single-Institution Experience

“…Approximately 0.5%-4.6% of intracranial aneurysms occur in patients 18 years of age or younger. [1][2][3][4][5][6][7] In a well-known study reported in 1966, only 41 of 6368 ruptured aneurysms were found in patients younger than 19 years. 8 Aneurysms in this population exhibit features that differ significantly from those in adults, including male predominance, a higher incidence of unusual anatomic locations such as the posterior circulation and internal carotid bifurcation, and greater numbers of giant aneurysms.…”

Rapid de novo aneurysm formation after clipping of a ruptured middle cerebral artery aneurysm in an infant with an MYH11 mutation

“…Other reports have commonly observed angiographic vasospasm in children who present with aneurysm rupture but have rarely noted its clinical significance. 10,13,19,21,23,26,38 In children younger than 2 years of age, however, vasospasm can be severe, possibly leading to debilitating large-vessel strokes, 34 probably due to high blood vessel reactivity. Reports on the use of nimodipine to reduce the risk of deficit from clinical vasospasm in children with aneurysmal SAH are limited, although its use in adults has been evaluated in the literature.…”