Hemorrhagic stroke in infancy, childhood, and adolescence

The authors report on factors influencing the outcome after hemorrhagic strokes in infants, children, and adolescents over a period of 14 years. Their series comprised primary hemorrhage in 24 cases (46.2%), including 5 cases of vitamin K deficiency; arteriovenous malformation in 20 cases (38.5%); intracranial aneurysm and moya-moya disease in 3 cases (5.7%) each; and spinal angioma in 2 cases (3.9%). Ten of 52 patients with juvenile hemorrhagic strokes died despite surgical treatment. These fatal cases involved an intraparenchymal hematoma with ventricular casts, and unilateral hydrocephalus suggesting acute, uncontrollable intracranial hypertension. The "child's biologic plasticity" plays an important role in the favorable prognosis in infants, children, and adolescents with hemorrhagic strokes. On the contrary, cases with intraventricular hemorrhage due to any pathologic condition have an unfavorable prognosis.