Stroke in children under 16 years of age. Clinical and etiological difference with adults

Giroud, Maurice; Lemesle, M.; Madinier, G.; Manceau, E.; Osseby, Guy‐Victor; Dumas, R

doi:10.1111/j.1600-0404.1997.tb00306.x

Cited by 94 publications

(58 citation statements)

References 23 publications

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“…The treatment parameters at the initial GKS were as follows: mean prescription dose 21.9 Gy (range 7.5-35 Gy); mean maximum dose 40.1 Gy (range 20-50 Gy); mean isodose line 56% (range 30%-90%); and mean number of isocenters 2.9 (range [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. The treatment parameters of the second GKS were as follows: mean prescription dose 20.7 Gy (range 4-27.5 Gy); mean maximum dose 39.6 Gy (range 8-50 Gy); mean isodose line 53% (range 50%-71%); and mean number of isocenters 4 (range .…”

Section: Treatment Parametersmentioning

confidence: 99%

Gamma Knife surgery for arteriovenous malformations in children

Yen¹,

Monteith²,

Nguyen³

et al. 2010

PED

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Object The aim of this study was to evaluate the long-term imaging and clinical outcomes of intracranial arteriovenous malformations (AVMs) in children treated with Gamma Knife surgery (GKS). Methods Between 1989 and 2007, 200 patients with AVMs who were 18 years of age or younger were treated at the University of Virginia Health System. Excluding 14 patients who had not reached 2-year follow-up, 186 patients comprised this study. Hemorrhage was the most common presenting symptom leading to the diagnosis of AVMs (71.5%). The mean nidus volume was 3.2 cm3 at the time of GKS, and a mean prescription dose of 21.9 Gy was used. Results After initial GKS, 49.5% of patients achieved total angiographic obliteration. Forty-one patients whose AVM nidi remained patent underwent additional GKS. The obliteration rate increased to 58.6% after a second or multiple GKS. Subtotal obliteration was achieved in 9 patients (4.8%). Forty-nine patients (26.3%) still had a patent residual nidus. In 19 patients (10.2%), obliteration was confirmed on MR imaging only. Ten patients had 17 hemorrhages during the follow-up period. The hemorrhage rate was 5.4% within 2 years after GKS and 0.8% between 2 and 5 years. Six patients developed neurological deficits along with the radiation-induced changes. Two patients developed asymptomatic meningiomas 10 and 12 years after GKS. After a mean clinical follow-up of 98 months, less than 4% of patients had difficulty attending school or developing a career. Conclusions Gamma Knife surgery offers a reasonable chance of obliteration of an AVM in pediatric patients. The incidence of symptomatic radiation-induced changes is relatively low; however, long-term clinical and imaging follow-up is required to identify delayed cyst formation and secondary tumors.

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Section: Treatment Parametersmentioning

confidence: 99%

Gamma Knife surgery for arteriovenous malformations in children

Yen¹,

Monteith²,

Nguyen³

et al. 2010

PED

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“…12 Although the underlying pathophysiological mechanism is uncertain, some authors have postulated a relationship between AVM size and feeding artery pressures. 8,12 Spetzler et al 17 found a higher rate of haemorrhagic presentation among smaller AVMs and noted that smaller AVMs were associated with higher feeding artery pressures at the time of surgical management as well as larger haematoma sizes. Diffuse AVM nidal morphology was identified as another independent risk factor for haemorrhage in our study.…”

Section: Discussionmentioning

confidence: 99%

“…[6][7][8] Studies in adults have identified radiological features that are associated with haemorrhagic presentation and future haemorrhage. [9][10][11] Similar studies on AVM in children are, however, scarce and mostly based on studies from Europe and North America.…”

Section: Introductionmentioning

confidence: 99%

Angiographic factors associated with haemorrhagic presentation of brain arteriovenous malformation in a Chinese paediatric population

et al. 2015

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Objective: To identify specific angiographic factors associated with haemorrhagic presentation of brain arteriovenous malformation in Chinese paediatric patients. Design:Retrospective cross-sectional observational study. Setting Main outcome measures:The following parameters were evaluated for their association with haemorrhagic presentation by univariate and multivariate analyses: nidus location, nidus size, nidus morphology (diffuse or compact); origin and number of arterial feeders; venous drainage; number of draining veins; presence of aneurysms, venous varices, and venous stenosis.Results: A total of 67 children and adolescents (28 male, 39 female) with a mean age of 12 years were included. Of them, 52 (78%) presented with haemorrhage. Arteriovenous malformation size (P=0.004) and morphology (P=0.05) were found to be associated with haemorrhagic presentation by univariate analysis. Small arteriovenous Angiographic factors associated with haemorrhagic presentation of brain arteriovenous malformation in a Chinese paediatric population New knowledge added by this study • Studies on paediatric arteriovenous malformation (AVM) are scarce and mostly based in Caucasian populations. This multicentre study involving Chinese paediatric patients found that small AVM nidus size and diffuse nidal morphology are independent risk factors for haemorrhage. Implications for clinical practice or policy • These two angiographic features associated with haemorrhagic presentation can help local clinicians to assess bleeding risk and determine the therapeutic approach (aggressive vs conservative) and treatment timeframe in paediatric patients with cerebral AVM.

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“…Os fatores de risco estão presentes em 60% a 90% das crianças com AVC isquémico e são sobretudo arteriopatias cerebrais, 4 doenças hematológicas (drepanocitose), cardiopatias, 5 estados protrombóticos 6,7 e infeção (meningite, sépsis, varicela). 5 No AVC hemorrágico é mais típica a existência de uma cefaleia súbita intensa, alteração do estado de consciência e convulsões. Está sobretudo associado a causas vasculares (malformação arteriovenosa), 8,9 doenças hematológicas e terapêutica anticoagulante.…”

Section: Introductionunclassified

Acidentes Vasculares Cerebrais em Idade Pediátrica: O Papel dos Cuidados Intensivos

Ferreira

Rebelo

Aguilar

et al. 2017

Acta Pediátrica Port

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Acta Pediatr Port 2017;48:245-52Resumo Introdução: As lesões vasculares do sistema nervoso central, nomeadamente o acidente vascular cerebral hemorrágico, o acidente vascular cerebral isquémico e trombose venosa cerebral, são causa importante de morbilidade e mortalidade. Existem poucos estudos sobre a melhor abordagem terapêutica em pediatria. O objetivo deste estudo foi descrever a abordagem e outcome neurológico dos doentes admitidos numa unidade de cuidados intensivos pediátricos com lesões vasculares cerebrais não traumáticas. Métodos: Estudo retrospetivo baseado nos processos clínicos de doentes internados numa unidade de cuidados intensivos pediátricos entre janeiro de 2007 e dezembro de 2013 com lesão vascular cerebral não traumática. Resultados: Incluíram-se 45 doentes, mediana da idade 8,2 anos, 70% do sexo masculino. Ocorreram 22 casos (49%) de acidente vascular cerebral hemorrágico, 15 de acidente vascular cerebral isquémico (33%) e oito de trombose venosa cerebral (18%). Necessitaram de intervenção neurocirúrgica 18 doentes e neurorradiológica cinco doentes. Um doente fez trombólise sistémica utilizando alteplase, 76% necessitaram de controlo médico da hipertensão intracraniana, 57% de ventilação mecâ-nica, 30% de suporte cardiovascular e 28% de terapêutica antiepilética. Ocorreram cinco óbitos (11%), quatro em doentes com acidente vascular cerebral hemorrágico. Utilizando a escala KOSCHI (King's Outcome Scale for Childhood Head Injury), atualmente 23 (51%) doentes são independentes, incluindo 17 que não apresentam qualquer sequela. Discussão: Registaram-se, em média, seis internamentos por ano por acidente vascular cerebral não traumático, sendo mais frequente o hemorrágico. A precocidade do diagnóstico e a referenciação atempada para centros especializados são cruciais para a melhoria do prognóstico. A abordagem multidisciplinar num centro com disponibilidade permanente de recursos humanos e materiais terá contribuído para a sobrevida e boa recuperação funcional verificada na maioria dos casos. Palavras-chave:Acidente Vascular Cerebral; Criança; Unidades de Cuidados Intensivos Pediátricos; Trombose Venosa Abstract Introduction: Vascular brain lesions, including haemorrhagic stroke, ischaemic stroke and cerebral venous thrombosis, are important causes of morbidity and mortality. Paediatric studies regarding the best therapeutic approach are scarce. The aim of this study was to describe the therapeutic approach and neurological outcome in patients admitted to a paediatric intensive care unit with non-traumatic vascular brain lesions. Methods: A retrospective analysis was conducted using medical records of patients with non-traumatic vascular brain lesions admitted to a paediatric intensive care unit between January 2007 and December 2013. Results: Forty-five patients were included, 70% male, median age 8.2 years. There were 22 cases (49%) of haemorrhagic stroke, 15 (33%) of ischaemic stroke and

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Stroke in children under 16 years of age. Clinical and etiological difference with adults

Cited by 94 publications

References 23 publications

Gamma Knife surgery for arteriovenous malformations in children

Gamma Knife surgery for arteriovenous malformations in children

Angiographic factors associated with haemorrhagic presentation of brain arteriovenous malformation in a Chinese paediatric population

Acidentes Vasculares Cerebrais em Idade Pediátrica: O Papel dos Cuidados Intensivos

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