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Evaluation of Cerebrovascular Events Followed in Pediatric Intensive Care Unit
Ulkem Kocoglu Barlas1, Nihal Akcay, Mehmet Emin Menentoglu
1Istanbul Medeniyet University, Faculty of Medicine, Department of Pediatrics, Pediatric Intensive Care Unit, Istanbul, Turkey.
Insights
Pediatric stroke prognosis improves with appropriate intensive care and treatment. This study highlights effective methods for managing pediatric stroke, aiming for low mortality and morbidity.
Area of Science:
- Pediatric Neurology
- Intensive Care Medicine
- Cerebrovascular Diseases
Background:
- Cerebrovascular events are uncommon in children but can have severe consequences.
- Effective management in pediatric intensive care units (PICU) is crucial for improving outcomes.
Purpose of the Study:
- To assess the impact of pediatric intensive care follow-up and specific treatment strategies on stroke patient prognosis.
- To analyze the characteristics and outcomes of pediatric stroke cases.
Main Methods:
- Retrospective analysis of 28 pediatric patients (28 days to 18 years) admitted to the PICU for stroke between 2011 and 2021.
- Categorization of stroke types including hemorrhagic stroke (HS) and acute ischemic stroke (AIS).
- Review of clinical presentations, affected brain regions, treatment modalities, and mortality rates.
Main Results:
- Hemorrhagic stroke (48.1%) and acute ischemic stroke (40.7%) were the most common diagnoses.
- Seizures and headache were frequent initial symptoms; seizures were more common in AIS.
- AIS patients experienced longer PICU stays and mechanical ventilation; HS patients underwent more endovascular embolization and decompressive surgeries. Overall mortality was 7.1%.
Conclusions:
- Pediatric stroke, though rare, can be managed effectively with appropriate diagnostic and treatment protocols.
- Achieving low mortality and morbidity in pediatric stroke patients is attainable through specialized intensive care and timely interventions.
Aim:
To evaluate the effect of intensive care follow-up and treatment methods on the prognosis of 28 patients admitted to the pediatric intensive care unit (PICU) due to stroke.
Material And Methods:
The data of patients aged between 28 days and 18 years followed up between 2011 and 2021 were recorded retrospectively.
Results:
Thirteen (48.1%) patients were diagnosed with hemorrhagic stroke (HS), 11 (40.7%) patients were diagnosed with acute ischemic stroke (AIS), and three (11.1%) patients were diagnosed with cerebral sinus vein thrombosis. One patient was followed up for non-ruptured arteriovenous malformation (AVM) and was excluded from the HS group. The HS group consisted of eight patients with ruptured AVMs and five patients with ruptured intracranial aneurysms. The patients had male predominance, and seizures and headache were the most common complaints on admission. The rate of admissions due to seizures was higher in the AIS group. In the HS group, there was more involvement of the right side of the brain. Middle cerebral artery (MCA) involvement was higher in the AIS group. The AIS group had longer PICU hospitalization days and mechanical ventilator days. While unfractionated heparin was preferred for the treatment in the AIS group, endovascular embolization was preferred in the HS group. Decompressive surgery was performed in five patients. The overall mortality rate was 7.1%.
Conclusion:
Although cerebrovascular events are rare in the pediatric population, achieving low mortality and morbidity is possible with the correct diagnostic and treatment methods.
