Nontraumatic Brain Hemorrhage in Children: Etiology and Presentation

Abstract

The clinical and radiographic findings of 68 children and adolescents with nontraumatic intraparenchymal brain hemorrhage were analyzed retrospectively. There were 43 boys and 25 girls, and the average age was 7.1 years (range, 3 months to 18 years). The most common presenting symptom was a combination of headache or vomiting (40 cases, or 58.8%). Hemiparesis was the major presenting sign in 11 (16.2%) of the children, seizures occurred in 25 (36.8%) patients, and 6 (8.8%) children were irritable. Only 2 (2.9%) children were comatose at presentation. One or more risk factors for hemorrhage were found in 61 (89.7%) of 68 children. A third (23 cases, or 33.8%) had an arteriovenous malformation or fistula; altogether 29 (42.6%) children had some type of congenital vascular anomaly. Hematologic or coagulation disorders were present in 22 (32.4%) patients, and 9 (13.2%) patients had brain tumors. Hemorrhage could not be attributed to systemic hypertension in any child. The likelihood of establishing the cause of bleeding was greater when evaluation included cerebral angiography (97.3% versus 80.4% without angiography). Half (34 cases, or 50.0%) of the patients regained normal neurologic function. Six (8.8%) patients died, either directly or partly as a consequence of the hemorrhage. The remaining patients had various neurologic sequelae, including 17 (25.0%) with hemiparesis, 5 (7.4%) with aphasia, 7 (10.3%) with epileptic seizures, and 3 (4.4%) with hydrocephalus. More detailed follow-up studies are needed to obtain more information about the frequency of cognitive sequelae.

Spontaneous Intracranial Hemorrhage in Children

“…This is slightly higher compared to that reported by Al-Jarallah et al [8] (mean age: 7.1 years, M:F = 1.3:1) and Meyer-Heim et al (mean age: 7 years, M:F = 1.3:1) [9]. …”

“…This is much a higher incidence compared to that reported in literature: Al-Jarallah et al [8 ](5.9%), Meyer-Heim et al [9] (15%) and Giroud et al [11]. 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].…”

“…Al-Jarallah et al [8] reported that the most frequent symptoms are those of increased intracranial pressure, such as headaches or vomiting. Other symptoms included seizure, hemiplegia and decreased mental state, in order of frequency.…”

“…In children, the cause of SICH is frequently a structural vascular disorder, such as AVM (14% [10] to 46% [11]), cerebral aneurysm (5.9% [8]), moyamoya disease, etc. In some cases, however, the cause is difficult to identify (table 7).…”

Spontaneous Intracranial Hemorrhage Caused by Pheochromocytoma in a Child

“…The etiology of spontaneous ICH in children falls into three main categories: vascular malformation (30–45%), hematological or coagulation disorders (15–30%) and neoplastic disorders (5–13%) [11, 12, 13, 14]. No cause for such hemorrhages is said to occur in up to 30% of pediatric patients [14].…”