Ischemic cerebrovascular disease in childhood: cognitive assessment of 15 patients

Rodrigues, Sônia das Dores; Ciasca, Sylvia Maria; Moura-Ribeiro, Maria Valeriana Leme de

doi:10.1590/s0004-282x2004000500012

“…90,91 Recurrence rates are high, justifying early diagnosis and primary or secondary preventative measures to reduce these complications. No standard treatment schemes have yet been proposed for managing stroke in children, with the majority of data having been drawn from consensus by specialists or extrapolated from reports in the literature on adult patients.…”

Section: Discussionmentioning

confidence: 99%

Acidentes vasculares encefálicos em pediatria

Filho¹,

Carvalho²

2009

J. Pediatr. (Rio J.)

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Objectives: To summarize 1) the definitions and epidemiological features of stroke in children; 2) the main risk factors that can lead to stroke in pediatrics and neonatology; 3) the main pathophysiological features involved in the genesis of brain injury in stroke; 4) the clinical manifestations and imaging diagnosis; and 5) the latest recommendations concerning the support measures, treatment, and prophylaxis of stroke in children.Sources: A review of the literature published in PubMed, EMBASE, and SciELO databases using the search terms stroke, pediatrics, and neonatology was performed, including relevant references from the chosen texts. Summary of the findings:Stroke in children are rare conditions, with incidence rates among two and eight per 100,000 children up to 14 years, and most cases show an underlying disease such as heart diseases, prothrombotic conditions, sickle-cell disease, and vascular malformations. There are no specific guidelines currently in place for the treatment of stroke in children, although central elements include support treatment, monitoring, and anticoagulation as secondary prevention in certain cases. Prognosis depends on the extent of brain damage and the underlying disease but recurrence rates are high in most cases. Conclusions:Early diagnosis of stroke in children is very important and pediatricians should be aware of the lack of specificity of the symptoms to avoid late sequelae and improve life quality.

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“…O diagnóstico do AVE é desafiador, particularmente em faixas etárias pediátricas mais jovens porque os sintomas frequentemente são pouco específicos. Sequelas neurológicas e comprometimentos neuropsicomotores de longo prazo são comuns, estando intimamente ligados à doença de base e à extensão das lesões cerebrais 90,91 .…”

Section: Conclusõesunclassified

Stroke in children

Filho¹,

Carvalho²

2009

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Objectives: To summarize 1) the definitions and epidemiological features of stroke in children; 2) the main risk factors that can lead to stroke in pediatrics and neonatology; 3) the main pathophysiological features involved in the genesis of brain injury in stroke; 4) the clinical manifestations and imaging diagnosis; and 5) the latest recommendations concerning the support measures, treatment, and prophylaxis of stroke in children.Sources: A review of the literature published in PubMed, EMBASE, and SciELO databases using the search terms stroke, pediatrics, and neonatology was performed, including relevant references from the chosen texts. Summary of the findings:Stroke in children are rare conditions, with incidence rates among two and eight per 100,000 children up to 14 years, and most cases show an underlying disease such as heart diseases, prothrombotic conditions, sickle-cell disease, and vascular malformations. There are no specific guidelines currently in place for the treatment of stroke in children, although central elements include support treatment, monitoring, and anticoagulation as secondary prevention in certain cases. Prognosis depends on the extent of brain damage and the underlying disease but recurrence rates are high in most cases. Conclusions:Early diagnosis of stroke in children is very important and pediatricians should be aware of the lack of specificity of the symptoms to avoid late sequelae and improve life quality.J Pediatr (Rio J). 2009;85(6):469-479: Stroke, pediatrics, neonatology, intensive care, anticoagulants. ResumoObjetivos: Listar 1) as definições e características epidemiológicas de acidentes vasculares encefálicos (AVE) em crianças; 2) os principais fatores de risco para a ocorrência de AVE em pediatria e neonatologia; 3) as principais características fisiopatológicas para a ocorrência de lesão cerebral no AVE; 4) as manifestações clínicas e o diagnóstico por imagem; e 5) as recomendações atualizadas para as medidas de suporte, tratamento e profilaxia dos AVE em pediatria. Fontes dos dados:Realizou-se revisão da literatura nas bases de dados PubMed, EMBASE e SciELO utilizando-se como palavras-chave stroke, pediatrics e neonatology, além da utilização de referências bibliográficas importantes dos textos escolhidos. Síntese dos dados:A ocorrência de AVE em pediatria é incomum, com a incidência variando entre duas e oito por 100.000 crianças abaixo de 14 anos, tendo a maioria como denominador comum a ocorrência de doenças de base como cardiopatias congênitas, anemia falciforme e malformações vasculares. Não há padronização nas recomendações de tratamento para o AVE em crianças, embora as medidas fundamentais incluam monitoração, tratamento de suporte e anticoagulação em casos selecionados. O prognóstico depende da extensão de área cerebral acometida e da doença de base, mas as taxas de recorrência são altas na maioria dos casos. Conclusões:O diagnóstico precoce dos AVE em pediatria é fundamental, e é importante que os pediatras estejam atentos à falta de especificidade...

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“…De Schryver et al 5 found impaired capacity for solving problems in post CVA children, when compared to the general population. Rodrigues et al 8 described children with CVA assed evolutionally by Piaget´s clinical method had present a performance significantly inferior when compared to the control group. The sequelae of a CVA during childhood are not yet as widely known as of one during adulthood; however, the more studies there are in the area, the more details shall be discovered, favoring professionals involved in the rehabilitation of such children 9 .…”

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confidence: 99%

Cerebrovascular disease in childhood: neuropsychological investigation of 14 cases

Guimarães

¹

,

Ciasca

²

,

Moura-Ribeiro

³

2007

Arq. Neuro-Psiquiatr.

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-There are few studies about the development of a child after a cerebrovascular accident (CVA), and they usually describe problems such as diminishing in intellectual capacities, difficulties in linguistic and visual-motor skills, as well as in spatial organization and integration. In this study, there were 28 children participating, being 14 placed in the experimental group (EG) after clinical diagnosis and ischemic CVA imaging, and other 14 children without past history of CVA, who formed the control group (CG). The neuropsychological research protocol included an intelligence test, a visual-motor coordination test, human figure drawing, a cortical functions battery and the medical records of the children from the EG. The analysis of the results of this study revealed that the best performances after the CVA are related to the shortest time of functional recovery; CG presented better performances than EG in all the instruments used, in cognitive, perceptual and motor skills. It has been noticed that CVA may lead to intellectual reduction in case of a recurrence of the vascular insult.KEY WORDS: cerebrovascular disease, childhood, neuropsycological investigation. Doença cerebrovascular na infância: investigação neuropsicológica em 14 casosRESUMO -Nos poucos estudos acerca do desenvolvimento da criança após o acidente vascular cerebral (AVC) são descritos problemas como rebaixamento intelectual, dificuldades na capacidade lingüística, visomotora, na organização e integração espacial. Neste estudo fizeram parte 28 crianças, sendo 14 pertencentes ao grupo experimental (GE) com diagnóstico clínico e de imagem de AVC isquêmico. Outras 14 crianças sem história de AVC que formaram o grupo controle (GC). O protocolo de investigação neuropsicológica constou de teste de inteligência, teste de coordenação viso-motor, desenho da figura humana, bateria de funções corticais e prontuário médico das crianças do GE. A análise dos resultados deste estudo mostrou que os melhores desempenhos após o AVC, estão relacionados ao menor tempo de recuperação funcional; houve desempenho superior do GC sobre o GE em todos os instrumentos utilizados, nas áreas cognitiva, perceptual e motora. Constatou-se ainda que o AVC pode levar a rebaixamento intelectual, quando ocorre um quadro de repetição do insulto vascular. PALAVRAS-CHAVE: doença cerebrovascular, infância, avaliação neuropsicológica.Literature shows that studies in the area of neuropsychological research with children who had cerebrovascular accident (CVA) are scarce; however, over the last years there has been a significant increase in studies which take into account neuroradiological and neurosurgerical aspects 1 . In the few studies on children development after CVA, neuropsychological deficits are described 2-6 . Armstrong et al.7 assessed 194 children with sickle cell anemia, amongst whom there were 9 with past history of CVA. These children presented difficulties in linguistic and visual-motor skills, as well as in spatial organization and integration. De Schryver et ...

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Ischemic cerebrovascular disease in childhood: cognitive assessment of 15 patients

Cited by 6 publications

References 10 publications

Acidentes vasculares encefálicos em pediatria

Acidentes vasculares encefálicos em pediatria

Stroke in children

Cerebrovascular disease in childhood: neuropsychological investigation of 14 cases

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