J Neurol Surg A Cent Eur Neurosurg 2015; 76 - A089
DOI: 10.1055/s-0035-1566408

Management of Hemorrhagic Stroke in Children

Alexandru Tascu 1, 2, A. Iliescu 1, C. Pascal 1, Iulia Balalau Vapor 1, R. E. Rizea 1, 2, Catalina Lipan 1, A. Spatariu 1, Irina Tudose 1
  • 1Neurosurgical Clinic, “Bagdasar – Arseni” Clinical Hospital, Bucharest, Romania
  • 2“Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania.

Introduction Hemorrhagic stroke in pediatric population is an uncommon pathology but an important cause of morbidity and mortality. The term hemorrhagic stroke usually includes spontaneous intracerebral hemorrhage (ICH) and non-traumatic subarachnoid hemorrhage (SAH). Incidence is ∼1 per 100,000 children. There are recommendations for treatment, but no management guidelines and clinical trials regarding this pathology in pediatric population. Treatment protocols for intracerebral hemorrhage have been elaborated for adult population. In children, one of the main causes of hemorrhagic stroke is represented by arteriovenous malformations (AVM), unlike adults, in which main causes are hypertension or amyloid angiopathy. In SAH, adult protocols are applied successfully.

Methods We reviewed our experience in a retrospective study, over a period of 15 years (2000–2014), including 134 patients younger than 18 years admitted in our clinic with hemorrhagic stroke. The following factors have been analyzed: age, gender, neurological status at admission, CT-scan at admission, DSA, MRI, treatment, complications, and outcome.

Results In our study, we included 134 patients, 71 boys (52.98%) and 63 girls (47.02%). Median age: 11.95 years. Eighty-eight patients have been admitted with intracerebral hemorrhage (65.67%) and 46 patients with subarachnoid hemorrhage (34.33%). The main cause of intracerebral hemorrhage has been ruptured AVMs (42.04%). Other causes of ICH have been cavernomas (11.36%), coagulopathies, and tumors. In 21.59% of cases with ICH, DSA was negative. In 34 cases (73.91%) of SAH, the etiology was ruptured aneurisms. In eight cases of ICH and in six cases of SAH, the etiology could not be investigated due to the poor neurological status of patients (GCS 3–4). Thirty-eight patients have been admitted with GCS score less than 8. Overall mortality was 14.17%. In this paper, we present our treatment strategies in hemorrhagic stroke in pediatric population.

Conclusion Hemorrhagic stroke is one of the top ten causes of death in pediatric population. Usually it is an acute event affecting a prior healthy child. Patients are often admitted in bad neurological status and require emergency treatment. To achieve best results in these cases, treatment guidelines for hemorrhagic stroke must be adapted to pediatric population.

Keywords hemorrhagic stroke; children; intracerebral hemorrhage; subarachnoid hemorrhage.