Spectrum of Intracerebral Hemorrhage in Children: A Report from PICU of a Resource Limited Country

Abstract

Intracerebral hemorrhage (ICH) in children is a rare but disabling disease that accounts for almost half cases of stroke. We report our experience of ICH in children. Retrospective review of medical records of children (1 month-16 years) admitted in Pediatric Intensive Care Unit between January 2007 and December 2014 was done. Data collected included age, gender, presentation, examination findings, neuroimaging done (CT, MRI, and angiography) management (conservative/intervention), and outcome. Results are presented as frequency and percentages. Of the total 50 patients, 58% were male and 26% were <1 year. On presentation 44% had vomiting, 42% had seizures, and GCS < 8 while 40% had altered level of consciousness. Single bleed was present in 88%, 94% had supratentorial bleed, and 32% had intraventricular extension. 72% had bleed volume of <30 mL and 8% had >60 mL. CT scan was done in 98% patients and MRI in 34%, while 6% underwent conventional angiography. 60% patients were managed conservatively, 36% underwent neurosurgical intervention, and 6% underwent radiological vascular intervention. Hematologic causes were identified in 52% patients and vascular malformations in 14% and in 26% no cause could be identified. 26% of patients expired.

Childhood haemorrhagic stroke: a 7-year single-centre experience

“…With respect to the underlying risk factors, our study concurs with the published literature: vascular diseases are the predominant risk factor for intracranial bleeding in a paediatric population (52% in our study vs 7%–91% in the literature) 13–23. In our cohort, vascular malformation was more common in elder children and was not present in the first year of life.…”

“…In our cohort, most children presented with vomiting, headache and an altered level of consciousness. This result is similar to literature where the headache is one of the main presenting symptoms 13–23. Headache is very frequently reported in children and adolescents in the general population and is one of the most common reasons for patients seeking medical advice from paediatricians.…”

Causes and Risk Factors of Pediatric Spontaneous Intracranial Hemorrhage—A Systematic Review

“…One article [ 20 ] was a duplicate. Data from the remaining 40 articles were extracted for the final data analysis [ 1 , 3 , 4 , 8 , 11 , 12 , 13 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ] (see Table 1 and Table S1 ).…”

Caracterización de los casos de ACV hemorrágico en la población pediátrica mayor de 1 mes en un hospital pediátrico de alta complejidad en la ciudad de Bogotá, Colombia durante los años 2012 a 2017

“…De estos, el hematoma intraparenquimatoso y la hemorragia subaracnoidea son los de mayor presentación. Al comparar esta presentación con los adultos, las causas hemorrágicas constituyen del 6,5 al 13% de todos los strokes 1,5,14 .…”