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Intracerebral haemorrhage after the neonatal period
Insights
Pediatric intracerebral hemorrhage is uncommon, with vascular malformations being the most frequent cause. This condition has a high mortality rate, but most survivors have mild handicaps.
Area of Science:
- Pediatric Neurology
- Neurocritical Care
- Pediatric Neurosurgery
Background:
- Intracerebral hemorrhage (ICH) is a rare but serious condition in children.
- Understanding the causes, clinical presentation, and outcomes of pediatric ICH is crucial for timely diagnosis and management.
Purpose of the Study:
- To review the experience of parenchymatous intracerebral hemorrhage in children over a 10-year period.
- To identify the common etiologies, clinical features, and outcomes of pediatric ICH.
Main Methods:
- Retrospective review of 27 pediatric cases (1 month to 16 years) of parenchymatous intracerebral hemorrhage.
- Analysis of etiologies, clinical presentations, and patient outcomes, including mortality and long-term handicaps.
Main Results:
- Vascular malformations were the most common etiology (10 cases), followed by hemorrhage into tumors (4) and coagulopathies (5).
- Clinical features were non-specific, with altered consciousness, headache, vomiting, and focal signs being most frequent.
- The overall mortality rate was 54% (14/27), with 9 patients experiencing handicaps at follow-up, none severe.
Conclusions:
- High clinical suspicion and early computed tomography are essential for diagnosing pediatric intracerebral hemorrhage.
- Management focuses on maintaining homeostasis, relieving intracranial pressure, and potential hematoma evacuation.
Abstract:
Intracerebral haemorrhage is rare in childhood. We have reviewed the last 10 years' experience, in our referral area, of parenchymatous intracerebral haemorrhage in children from 1 month to 16 years of age. There were 27 cases, five of which were intracerebellar and two predominantly intraventricular. The commonest aetiology was vascular malformation (10), followed by haemorrhage into tumour (four), and coagulopathies (five). Clinical features were non-specific, but altered consciousness, headache, vomiting, and focal signs were the most common. Focal signs were, however, rare in the patients with intracerebellar haemorrhage. There was an overall mortality of 54% (14 out of 27). Nine patients were handicapped on follow up, but none severely so. For the diagnosis of intracerebral haemorrhage a high level of clinical suspicion is needed with early use of computed tomography. Maintenance of homeostasis, relief of raised intracranial pressure, and evacuation of haematoma are the aims of management.