Nontraumatic brain hemorrhage in children: etiology and presentation
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Published on: June 18, 2021
A Al-Jarallah1, M T Al-Rifai, A R Riela
1Division of Child Neurology, University of Texas Southwestern Medical Center, Dallas, USA.
Insights
Nontraumatic brain hemorrhage in children is often linked to risk factors like vascular anomalies or clotting disorders. Early diagnosis with angiography improves outcome, though some patients experience lasting neurological deficits.
Area of Science:
- Pediatric Neurology
- Neuroradiology
- Clinical Pediatrics
Background:
- Nontraumatic intraparenchymal brain hemorrhage in children is a rare but serious condition.
- Understanding the clinical presentation, risk factors, and outcomes is crucial for effective management.
Purpose of the Study:
- To analyze the clinical and radiographic findings of children and adolescents with nontraumatic intraparenchymal brain hemorrhage.
- To identify common presenting symptoms, associated risk factors, and neurological outcomes.
Main Methods:
- Retrospective analysis of clinical and radiographic data from 68 pediatric patients.
- Evaluation included presenting symptoms, neurological signs, risk factor identification, and diagnostic imaging like cerebral angiography.
Main Results:
- Headache or vomiting was the most common symptom (58.8%).
- Risk factors were identified in 89.7% of cases, including congenital vascular anomalies (42.6%) and hematologic disorders (32.4%).
- Cerebral angiography increased the likelihood of identifying the bleeding cause (97.3% vs. 80.4%).
Conclusions:
- Congenital vascular anomalies and hematologic disorders are significant risk factors for pediatric brain hemorrhage.
- Cerebral angiography is vital for diagnosing the cause of bleeding.
- While 50% of patients recovered normal neurologic function, significant sequelae such as hemiparesis and seizures occurred in others.
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.
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