Intracranial vasospasm with subsequent stroke after traumatic subarachnoid hemorrhage in a 22-month-old child

Abstract

<jats:p>Clinical and radiographic evidence of subarachnoid hemorrhage (SAH)-related vasospasm is rare in children and has not been reported in infants. In this report the authors present the case of a 22-month-old child who developed clinically symptomatic, radiographically identifiable vasospasm after traumatic SAH. To the authors' knowledge, this is the first report of vasospasm associated with SAH in a child this young. This 22-month-old boy fell and had a dense SAH. He had a history of surgically corrected craniosynostosis and nonsymptomatic ventriculomegaly. The boy was evaluated for occult vascular lesions using imaging; none were found and normal vessel caliber was noted. Ten days later, the child developed left-sided weakness and a right middle cerebral artery infarct was identified. Evaluation disclosed significant intracranial vasospasm. This diagnosis was supported by findings on CT angiography, transcranial Doppler ultrasonography, MR imaging, and conventional angiography. The child was treated using intraarterial verapamil with a good result, as well as with conventional intensive care measures to reduce vasospasm. This report documents the first known case of intracranial vasospasm with stroke after SAH in a patient under the age of 2 years. This finding is important because it demonstrates that the entity of SAH-associated vasospasm can affect the very young, widening the spectrum of ages susceptible to this condition. This case is also important because it demonstrates that even very young children can respond to conventional therapeutic interventions such as intraarterial verapamil. Thus, clinicians need to be alert to the possibility of vasospasm as a potential diagnosis when evaluating young children with SAH.</jats:p>

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

“…Some patients may benefit from triple-H therapy-hypertension, hypervolemia, and hemodilution-to reduce the risk of vasospasm (after aneurysm treatment). 484,485 The value of using calcium channel blocking agents (eg, nimodipine) in children is unknown.…”

The identification of a subgroup of children with traumatic subarachnoid hemorrhage at low risk of neuroworsening

“…7,10,11,15,24,25 While it has been suggested that the presentation of SAH is similar in adult and pediatric patients, 23 specific data regarding the outcomes and management of SAH in the pediatric population remain limited. 31 Risk stratification of pediatric patients with tSAH could allow for the identification of those at low risk for neuroworsening, preventing potentially unnecessary ICU admissions with attendant associated interventions, limiting additional exposure to ionizing radiation and administration of anesthetic agents, and improving overall healthcare efficiencies. In this paper we present the clinical course and neurological outcomes of 51 consecutive pediatric patients with isolated tSAH and mild TBI (GCS score [13][14][15] identified in a prospectively collected database of 10,395 pediatric trauma patients admitted over a 10-year period.…”

Hidden Dense Middle Cerebral Artery Sign in a 4-Year-Old Boy With Traumatic Subarachnoid Hemorrhage

“…There is only 1 report about a child with middle cerebral artery cortical infarction caused by vasospasm. 2 We describe the case of a 4-year-old boy who experienced right hemiparesis and motor aphasia due to a striatocapsular infarction after a traumatic subarachnoid hemorrhage.…”

“…There is only 1 report about a child with middle cerebral artery cortical infarction caused by vasospasm. 2…”