Intracranial Arterial Aneurysms in Infancy and Childhood

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.

Section: Discussionmentioning

confidence: 47%

“…Intracranial aneurysms have been found to have a sex predilection for young boys compared to girls with an approximate ratio of 1.8:1 [33, 34]. Aneurysms in pediatric populations are more likely to present with SAH [33, 35, 36]. In the present series, there were 16 cases of SAH and only 1 case of intraventricular bleed secondary to aneurysm.…”

Section: Discussionmentioning

confidence: 67%

Spontaneous Intracranial Hemorrhage in Children

Kumar

Shukla

Mahapatra³

2009

“…The most common presentation of intracranial aneurysms in children is subarachnoid hemorrhage [10,15,17]. Presentation secondary to mass effect (i.e.…”

Section: Discussionmentioning

confidence: 99%

“…There is a higher incidence of giant aneurysms (12.5 cm) in children compared to adults [10,15,19]. In addition, aneurysms in children are more likely to occur at the internal carotid bifurcation [17,20,21] or the posterior circulation [15,19,21]. However, some authors have found these aneurysms to be more peripherally located [10,22].…”

Section: Discussionmentioning

confidence: 99%

Unusual Association of Intractable Temporal Lobe Seizures and Intracranial Aneurysms in an Adolescent: Is It a Coincidence?

Baeesa

Dang²,

Keene³

et al. 1998

Intracranial aneurysms in the pediatric age group are rare occurrences. They usually present with subarachnoid hemorrhage or mass effect. Their association with epilepsy has rarely been reported; such concurrence may not be a coincidence. We present a 16-year-old girl with a 5-year history of medically intractable complex partial seizures. Preoperative electrophysiological and neuroimaging studies demonstrated an epileptogenic focus and atrophy in the right mesial temporal lobe, and ipsilateral incidental aneurysm at the carotid artery bifurcation. The patient underwent a complete right anterior temporal lobectomy, followed by clipping of the aneurysm. We concluded that the epilepsy management in association with cerebral aneurysms is controversial, but when surgery is indicated, clipping of the aneurysm and resection of the epileptogenic focus may provide the optimal outcome. The relevant literature is reviewed and the possible mechanisms of production of epilepsy by intracranial aneurysms are discussed.

“…As well, traumatic intracranial aneu rysms are recognized to be rare, comprising less than 0.5% of all intracranial aneurysms in a large hospital series spanning roughly 20 years [4], However, roughly one fourth of the reported traumatic aneurysms have involved pediatric patients [5]. Such numbers indicate that either traumatic intracranial aneurysms are more common in the pediatric versus the adult population [3,6] or that some bias exists for reporting such aneurysms in children as compared to adults. A comprehensive review of the lit erature in 1988 revealed 69 well-documented cases of traumatic intracranial aneurysms in childhood, with an overall mortality rate of 31%, but with roughly 2/3 of all operated cases resulting in a good or excellent outcome [7], Since that time several additional papers concerning traumatic intracranial aneurysms have been published …”

Section: Introductionmentioning

confidence: 99%

Pediatric Traumatic Intracranial Aneurysms

Pa¹,

Jg²,

Raffel³

1995

During the past 17 years, 7 children have been treated at Children’s Hospital Los Angeles (CHLA) for traumatic intracranial aneurysms. These patients presented with subarachnoid or intraparenchymal hemorrhage (5 cases), growing fracture (1 case), and behavioral change (1 case). All patients were managed with surgery, and no patient died or was made neurologically worse as a result of such management. The existence of a traumatic aneurysm should be considered when new neurological symptoms develop in a patient with a history of head injury.