Etiology, clinical characteristics and prognosis of spontaneous intracerebral hemorrhage in children: A prospective cohort study in China

Liu, Junfeng; Wang, Deren; Lei, Chunyan; Xiong, Yao; Yuan, Ruozhen; Zeng, Hao; Tao, Wendan; Liu, Ming

doi:10.1016/j.jns.2015.09.366

Cited by 25 publications

(16 citation statements)

References 17 publications

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“…Causes Nontraumatic, spontaneous ICH, IVH, and SAH in childhood are caused by structural lesions in up to ≈75% of cases, with brain AVMs found most commonly and ≈10% of hemorrhages remaining idiopathic (Table 3). [396][397][398][399][400][401] Acute Management of Childhood Hemorrhagic Stroke When a hemorrhagic stroke is suspected in a child, emergency head imaging should be performed to make the diagnosis; CT scans are most often performed because of their ready availability in EDs and high sensitivity for hemorrhage. On diagnosis, initial management is predicated on stabilizing the patient, establishing a diagnosis, and preventing secondary neurological injury.…”

Section: Hemorrhagic Stroke In Childhoodmentioning

confidence: 99%

“…[396][397][398][399][400][401] Hemorrhage risk is estimated at up to ≈6%/y in recent studies, with a mortality rate of ≈25% per hemorrhage, providing an impetus to treat if possible. 401,[421][422][423][424] Diagnosis is typically initially made with CTA or MRA, although DSA is ultimately needed to make treatment decisions in most cases because it offers the greatest resolution of nidal anatomy. 425,426 DSA is low risk and high yield.…”

Section: Pathogenesis-specific Evaluation Treatment and Follow-up Amentioning

confidence: 99%

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Management of Stroke in Neonates and Children: A Scientific Statement From the American Heart Association/American Stroke Association

Ferriero¹,

Fullerton²,

Bernard³

et al. 2019

Stroke

450

506

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Purpose-Much has transpired since the last scientific statement on pediatric stroke was published 10 years ago. Although stroke has long been recognized as an adult health problem causing substantial morbidity and mortality, it is also an important cause of acquired brain injury in young patients, occurring most commonly in the neonate and throughout childhood. This scientific statement represents a synthesis of data and a consensus of the leading experts in childhood cardiovascular disease and stroke. Methods-Members of the writing group were appointed by the American Heart Association Stroke Council's Scientific Statement Oversight Committee and the American Heart Association's Manuscript Oversight Committee and were chosen to reflect the expertise of the subject matter. The writers used systematic literature reviews, references to published clinical and epidemiology studies, morbidity and mortality reports, clinical and public health guidelines, authoritative statements, personal files, and expert opinion to summarize existing evidence and to indicate gaps in current knowledge. This scientific statement is based on expert consensus considerations for clinical practice. Results-Annualized pediatric stroke incidence rates, including both neonatal and later childhood stroke and both ischemic and hemorrhagic stroke, range from 3 to 25 per 100 000 children in developed countries. Newborns have the highest risk ratio: 1 in 4000 live births. Stroke is a clinical syndrome. Delays in diagnosis are common in both perinatal and childhood stroke but for different reasons. To develop new strategies for prevention and treatment, disease processes and risk factors that lead to pediatric stroke are discussed here to aid the clinician in rapid diagnosis and treatment. The many important differences that affect the pathophysiology and treatment of childhood stroke are discussed in each section. Conclusions-Here we provide updates on perinatal and childhood stroke with a focus on the subtypes, including arterial ischemic, venous thrombotic, and hemorrhagic stroke, and updates in regard to areas of childhood stroke that have not received close attention such as sickle cell disease. Each section is highlighted with considerations for clinical practice, attendant controversies, and knowledge gaps. This statement provides the practicing provider with much-needed updated information in this field. (Stroke. 2019;50:e00-e00.

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Section: Hemorrhagic Stroke In Childhoodmentioning

confidence: 99%

Section: Pathogenesis-specific Evaluation Treatment and Follow-up Amentioning

confidence: 99%

Management of Stroke in Neonates and Children: A Scientific Statement From the American Heart Association/American Stroke Association

Ferriero¹,

Fullerton²,

Bernard³

et al. 2019

Stroke

450

506

View full text Add to dashboard Cite

show abstract

“…In a recent study, the commonest cause of spontaneous ICH in children was arteriovenous malformation (63% of patients), and hypertension was found in just 1 out of 70 patients. 5 There are specific mechanisms by which hypertension causes ICH. A high intraluminal pressure in the intracerebral arteries leads to extensive alterations in the smooth muscle wall and endothelium functions.…”

Section: Hypertension As a Causative Factor In Hemorrhagic Strokesmentioning

confidence: 99%

Hypertension and Hemorrhagic Stroke

Kumar¹

2017

Hypertension Journal

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Hemorrhagic strokes are common and account for 20 to 30% of all strokes in India and the rest of Asia. Patients admitted with intracerebral hemorrhage (ICH) are usually sicker, and ICH is associated with worse outcomes (as compared with ischemic strokes). Hypertension is the commonest risk factor for spontaneous ICH, responsible for up to 80% of all cases of ICH, either alone or in combination with other etiological factors. Elevated blood pressure (BP) during the first few hours to days after ICH leads to worse outcomes (higher death and disability rates). This is because high BP is directly linked to hematoma expansion and increased mass effect. Therefore, rapid lowering of BP is recommended if systolic BP > 160 mm Hg. Intravenous labetalol and nicardipine are both equally safe and effective for this purpose. Survivors of ICH have a higher risk of developing recurrence of ICH both over the short term and over the long term. Aggressive BP lowering is recommended in ICH survivors postdischarge from the hospital. The target BP of <130/80 mm Hg should be maintained in them to reduce the risk of ICH recurrence.

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“…Similar findings are also reported in two other patient cohorts. 9,10 In addition, a study by Liu et al 6 of 70 Chinese children found that the level of disability improved significantly between 3 months and 6 months after ICH. Taken together, findings in previous studies generally suggest improvement in physical disability when assessed months to years after cerebral hemorrhage 11 but a significant reduction in quality of life persists.…”

mentioning

confidence: 97%

“…Previous studies of intracerebral hemorrhage (ICH) and hemorrhagic stroke in childhood have simply reported neurological outcome qualitatively as 'normal', 'good', or 'poor' 1,2 or have used disability scales or measures of global neurological outcome that are heavily influenced by sensorimotor function. [3][4][5][6][7] One larger study by Lo et al 8 reported neurological outcome as well as quality of life after pediatric ICH. From a group of 59 children, there were 39 survivors; follow-up was available in 19 children at a median of 6 years 7 months after ICH.…”

mentioning

confidence: 99%

Cognitive functioning over 2 years after intracerebral hemorrhage in school‐aged children

Murphy

Compas

Gindville

et al. 2017

Develop Med Child Neuro

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AIM Previous research investigating outcomes after pediatric intracerebral hemorrhage (ICH) has generally been limited to global and sensorimotor outcomes. This study examined cognitive outcomes after spontaneous ICH in school-aged children with serial assessments over 2 years after stroke. METHOD Seven children (age range 6–16y, median 13; six males; 57% white, 43% black) presenting with spontaneous ICH (six arteriovenous malformations) were assessed at 3, 12, and 24 months after stroke. The Pediatric Stroke Outcome Measure (PSOM) quantified neurological outcome and Wechsler Intelligence Scales measured cognitive outcomes: verbal comprehension, perceptual reasoning, working memory, and processing speed. RESULTS PSOM scales showed improved neurological function over the first 12 months, with mild to no sensorimotor deficits and moderate overall deficits at 1- and 2-year follow-ups (median 2-year sensorimotor PSOM=0.5, total PSOM=1.5). Changes in cognitive function indicated a different trajectory; verbal comprehension and perceptual reasoning improved over 24 months; low performance was sustained in processing speed and working memory. Age-normed centile scores decreased between 1- and 2-year follow-ups for working memory, suggesting emerging deficits compared with peers. INTERPRETATION Early and serial cognitive testing in children with ICH is needed to assess cognitive functioning and support children in school as they age and cognitive deficits become more apparent and important for function.

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Etiology, clinical characteristics and prognosis of spontaneous intracerebral hemorrhage in children: A prospective cohort study in China

Cited by 25 publications

References 17 publications

Management of Stroke in Neonates and Children: A Scientific Statement From the American Heart Association/American Stroke Association

Management of Stroke in Neonates and Children: A Scientific Statement From the American Heart Association/American Stroke Association

Hypertension and Hemorrhagic Stroke

Cognitive functioning over 2 years after intracerebral hemorrhage in school‐aged children

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