Spontaneous Intracranial Hemorrhage in Children

Abstract

Aim: Spontaneous intracranial hemorrhage (SICH) in children is relatively less common as compared to adults, and there are limited studies addressing this issue in children. In this study, we analyze the etiology, clinical features, treatment options and outcome assessment in this population. Material and Methods: Fifty consecutive patients of spontaneous intracerebral bleed, aged 18 years and below, were retrospectively analyzed based on medical records and radiographic images. Status of the patient at the final follow-up after discharge was considered as the outcome. Results: Age of patients ranged from 2 months to 17 years with higher predilection in males (M:F = 3:2). Presenting features were symptoms of raised intracranial pressure (70.0%), deterioration in sensorium (50.0%), limb weakness (36.0%) and seizures (28%). Arteriovenous malformation (AVM) was the most common cause of hemorrhage, and was found in 22 patients (44%), followed by cerebral aneurysm in 17 cases (34%), moyamoya disease in 3 cases (6%), and intracranial tumor, hematological disorders and unknown cause (possible vasculitis) were each found in 2 patients (4%). Treatment modalities consisted of: excision of AVM, aneurysm clipping, embolization, superficial temporal artery to middle cerebral artery bypass, tumor excision, hematoma evacuation and conservative management. Thirty-five patients (74%) had good outcome and 13 patients had poor outcome (26%). Conclusions: Aneurysm is an important cause of SICH, alongside AVM, which is the leading cause. Thorough investigation is necessary to elucidate the cause of bleed, which may otherwise be missed. Cerebellar bleed and late presentation were found to be associated with poor outcome. Age was not found to be associated with outcome.

Multimodality treatment approach in children with cerebral arteriovenous malformation—a survey in the Danish population

“…Most publications report a male preponderance [1,5,8], which is consistent with our findings (23/40 boys). Analyzing the mortality from childhood stroke in England and Wales over several decades, it was found that hemorrhage accounted for 71% of the deaths.…”

“…In our study, we found the incidence of symptomatic AVM in children to be 0.4/100,000, compared to the incidence of 0.7/100,000 estimated from previous publications [5]. In order to obtain the true incidence, it would be necessary to include not only children admitted with a definite diagnosis of AVM but also those with a postmortem diagnosis of AVM.…”

“…Any type of stroke in the pediatric age group is rare (approximately 3/100,000). Hemorrhage accounts for half of the cases in pediatric cerebrovascular disease, and almost half of these are caused by AVM rupture [5]. The incidence of ruptured AVM in children inferred from the literature is thus approximately 0.7/ 100,000.…”

Ketepatan Parameter Klinis dalam Memprediksi Mortalitas Perdarahan Intrakranial Spontan pada Anak Usia Kurang dari Satu Tahun

“…Penelitian sebelumnya melaporkan bahwa adanya gangguan perdarahan akan sangat memengaruhi mortalitas, dengan angka kematian subyek dengan gangguan perdarahan hingga 41%. 10,12,13 Pemanjangan apTT menunjukkan derajat gangguan perdarahan dan kadar Hb dapat berhubungan dengan derajat dan lama perdarahan yang terjadi. Penurunan GCS dan refleks cahaya mungkin mencerminkan derajat proses desak ruang akibat peningkatan tekanan intrakranial.…”

“…Temuan ini berbeda dengan data terdahulu yang menunjukkan bahwa perdarahan lebih dari satu lokasi dan jenis perdarahan subdural memiliki prognosis lebih buruk. 13,14 Perbedaan tersebut kemungkinan dikarenakan penyebab perdarahan dan lebih banyaknya perdarahan subdural pada penelitian kami. Kami tidak memperhitungkan pengaruh jumlah perdarahan, jenis operasi, dan lama rawat yang RKP=rasio kemungkinan positif; RKN=rasio kemungkinan negatif; COP=cut off point merupakan keterbatasan penelitian ini karena faktor tersebut mungkin dapat berpengaruh.…”