Predictors of Outcome in Childhood Intracerebral Hemorrhage

Abstract

Background and Purpose— The purposes of this study were to describe features of children with intracerebral hemorrhage (ICH) and to determine predictors of short-term outcome in a single-center prospective cohort study. Methods— A single-center prospective consecutive cohort study was conducted of spontaneous ICH in children aged 1 to 18 years from January 2006 to June 2008. Exclusion criteria were inciting trauma; intracranial tumor; isolated epidural, subdural, intraventricular, or subarachnoid hemorrhage; hemorrhagic transformation of ischemic stroke; and cerebral sinovenous thrombosis. Hospitalization records were abstracted. Follow-up assessments included outcome scores using the Pediatric Stroke Outcome Measure and King’s Outcome Scale for Childhood Head Injury. ICH volumes and total brain volumes were measured by manual tracing. Results— Twenty-two patients, median age 10.3 years (range, 4.2 to 16.6 years), had presenting symptoms of headache in 77%, focal deficits 50%, altered mental status 50%, and seizures 41%. Vascular malformations caused hemorrhage in 91%. Surgical treatment (hematoma evacuation, lesion embolization or excision) was performed during acute hospitalization in 50%. One patient died acutely. At a median follow-up of 3.5 months (range, 0.3 to 7.5 months), 71% of survivors had neurological deficits; 55% had clinically significant disability. Outcome based on Pediatric Stroke Outcome Measure and King’s Outcome Scale for Childhood Head Injury scores was worse in patients with ICH volume >2% of total brain volume ( P =0.023) and altered mental status at presentation ( P =0.005). Conclusions— Spontaneous childhood ICH was due mostly to vascular malformations. Acute surgical intervention was commonly performed. Although death was rare, 71% of survivors had persisting neurological deficits. Larger ICH volume and altered mental status predicted clinically significant disability.

High critical care usage due to pediatric stroke

“…For comparison, published case fatality rates for overall medical admissions to pediatric ICUs in the United Kingdom, 13 Sweden, 14 and the Netherlands 15 range from 2% to 5%. Prior hospital series of childhood stroke have reported case fatality rates of 2%-9% for ischemic stroke 3,12,16 and 5%-34% for hemorrhagic stroke, 12,17,18 but have not stratified outcomes of strokes admitted for critical care. Our study validates that even in a population-based cohort without referral bias, childhood stroke is a highly morbid disease.…”

Pediatric Neurocritical Care

“…Recent studies have characterized risk factors and presenting symptoms in children. Vascular anomalies, including arteriovenous malformations, arterial-venous fistulas, and aneurysms appear to be the most common factor and are associated with 42 to 90% of cases [134][135][136]. Other important factors include brain tumors (9-13%) and medical illnesses (23-32%).…”

Clinical Profile of Patients with non Traumatic Intracranial Bleed: An Observational Study at a Tertiary level Hospital in India

“…Cerebral amyloid angiopathy is the most common cause of nontraumatic lobar ICH in the elderly, while vascular malformations are the most common cause of ICH in children. 4 Nontraumatic ICH causes 8 to 15% of all first-ever strokes in Australia, England, and the United States 5 . it accounts for 25% of strokes in Japan 6 .…”