Delayed diagnosis of intracranial aneurysm in pediatrics: the risk of misdiagnosis—a case report

Demartini, Zeferino; Alencar, Guilherme dos Santos de; Cardoso-Demartini, Adriane; Sprengel, Sergio Luiz; Zanine, Simone Cristina; Borba, Luis A. B.

doi:10.1007/s00381-020-05006-6

Cited by 4 publications

(3 citation statements)

References 10 publications

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“…The advances in imaging have facilitated the detection of aneurysms in children, although pediatricians should have a high index of suspicion for diagnosis, especially in small children [5,15]. The female predilection of aneurysms in adults is the opposite of what is seen in childhood.…”

Section: Discussionmentioning

confidence: 99%

Pediatric intracranial aneurysms in a Southern Brazilian population

et al. 2023

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Introduction: Aneurysms are rare in the pediatric population and its diagnosis can be challenging. They differ from their adult counterparts in several aspects, and hemorrhage is the most frequent presentation.Objective: To evaluate clinical data, aneurysms characteristics and therapeutic results in a series of patients <18 years of age with intracranial aneurysms.Method: A retrospective cross-sectional observational study design through the analysis of medical records and imaging studies. Analyzed data included age, sex, presentation, comorbidities, aneurysmal characteristics, treatment modality and clinical outcomes.Results: 15 intracranial aneurysms were identi ed in 11 patients (6 male), with ages ranging from 3 months to 15 years (mean 5.2 years). Five patients had associated medical conditions, and hemorrhage was the most frequent clinical presentation (45%). Three patients (27%) had multiple aneurysms, and 7 aneurysms were fusiform or dysplastic. The internal carotid artery was the most affected site, occurring in 47% of cases. Aneurysm size ranged from 2 mm to 60 mm (mean 16.8 mm), with giant aneurysms in 27%. Seven patients were treated via endovascular procedures and three aneurysms were clipped. Symptomatic vasospasm requiring angioplasty occurred in two patients. One patient died due to severe aspiration pneumonia and sepsis that precluded treatment. Good functional outcome (mRS < 2) was achieved in all patients submitted to treatment (91%). Conclusion:The patients with aneurysms in this series were characterized by hemorrhagic presentation, mild male predominance, and internal carotid artery involvement. The outcome of treated patients was favorable, regardless of the treatment modality.Compliance with Ethical Standards: The study was approved by the Ethics Committee of Hospital Pequeno Principe. It was performed in accordance with the ICMJE Recommendations for the Protection of Research Participants. Written informed consent for publication of data and images was provided and signed by the patient's surrogates. All patients' identi cations were removed to preserve anonymity.Con ict of Interest Statement: The authors declare no con icts of interest.

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Section: Discussionmentioning

confidence: 99%

Pediatric intracranial aneurysms in a Southern Brazilian population

et al. 2023

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“…gov/), we found 103 publication records with search terms, "intracranial", "aneurysms" and "pediatric". Among them, 21 patients were reportedly under 3 years of age (12 females; 1 months to 2 years) at onsets (Table 1) [4,5,[7][8][9][10][11][12]. Although variable degrees of neurological deficits were left, none of them died or failed to receive neurosurgical operations for their critical conditions.…”

Section: Case Presentationmentioning

confidence: 99%

Quantitative indices for an intracranial aneurysm and subarachnoid hemorrhage in early childhood: a case report

et al. 2022

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Background Intracranial aneurysms (ICA) rarely occur in children under 3 years of age. Little is known for neuroimaging parameters that predict survival and clinical outcomes of patients with ICA in early childhood. Case presentation A 2-year-old girl showed intracranial hemorrhage due to a rupture of aneurysm at the middle cerebral artery. Quantitative measurements of ischemic damages on the head computed tomography (CT) marked an extremely low score of 2 points with modified Alberta Stroke Program Early CT Score (mASPECTS). She died 15 days after admission. In publications from 2021 to 2022, we found 21 children who were under 3 years of age at onset of ICA. None of them died, but two of three patients who had mASPECTS scores 0–8 showed developmental delay and/or epilepsy as neurological complications. Conclusion Early CT findings are applicable for predicting survival and neurological outcomes of young children with intracranial hemorrhage.

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“…Since neurocutaneous disorders may have heterogeneous systemic involvement, further studies are needed to confirm the possibility of carotid artery involvement in HI. In addition to conventional MR sequences, specific vascular neuroimaging should be considered for children with HI and abnormal neurological findings to prevent a misdiagnosis [7].…”

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Carotid Artery Aneurysm and Hypomelanosis of Ito

Demartini¹,

Teixeira²,

Koppe³

2023

Pediatr Neurosurg

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Introduction: Hypomelanosis of Ito is a rare neurocutaneous syndrome characterized by hypopigmented skin lesions, abnormalities of the central nervous system, skeletal system, eyes and teeth. Case Presentation: We present a case of a 4-year-old boy with hypomelanosis of Ito and neck pulsatile mass due to a giant left common carotid dissecting aneurysm. Discussion: To our knowledge, this is the first report of association of hypomelanosis of Ito with carotid aneurysm. Conclusion: For children with hypomelanosis of Ito and abnormal neurologic findings, vascular neuroimaging should be considered.

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Delayed diagnosis of intracranial aneurysm in pediatrics: the risk of misdiagnosis—a case report

Cited by 4 publications

References 10 publications

Pediatric intracranial aneurysms in a Southern Brazilian population

Pediatric intracranial aneurysms in a Southern Brazilian population

Quantitative indices for an intracranial aneurysm and subarachnoid hemorrhage in early childhood: a case report

Carotid Artery Aneurysm and Hypomelanosis of Ito

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