Related Experiment Videos
Spontaneous intracerebral hemorrhage in children
1Department of Neurosurgery, Kaohsiung Medical College Hospital, Taiwan, Republic of China.
Insights
Spontaneous intracerebral hemorrhage (ICH) in children presents with non-specific symptoms like headache and vomiting. Despite low incidence, prompt diagnosis is crucial for better outcomes, with most children achieving good recovery.
Area of Science:
- Pediatric Neurology
- Neuroradiology
- Pediatric Neurosurgery
Background:
- Spontaneous intracerebral hemorrhage (ICH) is rare in children, often presenting with non-specific symptoms.
- Accurate diagnosis and understanding of causes are vital for effective management in pediatric patients.
Purpose of the Study:
- To review the clinical experience with spontaneous intracerebral hemorrhage (ICH) in children.
- To identify common presenting symptoms, etiological factors, and outcomes in pediatric ICH cases.
Main Methods:
- Retrospective review of 42 children (<16 years) with spontaneous ICH treated between 1989-1997.
- Analysis of clinical presentation, Glasgow Coma Scale (GCS) on admission, diagnostic imaging (cerebral angiography, MRI), and etiological factors.
- Evaluation of in-hospital and long-term recovery outcomes.
Main Results:
- Headache, loss of consciousness, and vomiting were the most frequent symptoms.
- Arteriovenous malformations (AVMs) were the leading identified cause of ICH.
- In-hospital survival was 79%, with 70% achieving good recovery at long-term follow-up; motor function recovery was rapid, but visual deficits persisted.
Conclusions:
- Physicians should consider ICH in children, even with non-specific symptoms, due to potential for good recovery.
- ICH in pediatric patients requires prompt diagnosis and management, considering specific risk factors and prognostic indicators.
- While motor deficits may improve, visual impairments often remain a long-term challenge in pediatric ICH survivors.
Abstract:
We reviewed our experience in 42 children younger than 16 years with spontaneous intracerebral hemorrhage (ICH) treated between January 1989 and December 1997. Glasgow coma scale (GCS) on admission was 15 in 21 (50%) patients. The most frequent presenting symptoms were headache in 28 (67%) patients, followed by loss of consciousness in 22 (52%) patients and vomiting in 21 (50%) patients. Three cases were diagnosed initially as meningitis and two cases as common cold. The locations of ICH were lobar (26 patients) and cerebellar (7). Cerebral angiographies were performed on 28 patients, and were diagnostic in 19 (68%). Magnetic resonance imaging (MRI) scans revealed two cases of cavernous angiomas, which were confirmed by the pathologic studies of surgical specimens. Laboratory examinations detected two cases of acute leukemia. Four categories of the causes of ICH were determined in 23 (55%) patients. The leading cause of bleeding was arteriovenous malformations (AVMs). The in-hospital survival rate of all patients in this study was 79%. Patients with GCS 3-5 on admission and ICH located at brain stem, cerebellum, and multiple subcortical areas had higher mortality rates. On the follow-up (mean 42 months), seventy percent of our cases had made a good recovery, 21% a fair recovery, 3% a poor recovery, and 6% had died. Children with ICH recover motor function more rapidly than adults. However, visual deficits always persist at our long-term follow-up examinations. A physician should keep in mind the diagnosis of ICH in children, even though the presenting symptoms may be non-specific and the incidence of ICH is very low in children.