FV 396. Childhood Hemorrhagic Stroke—A 7-Year Single-Center Experience

Background: In recent years, there has been increasing research interest in understanding the underlying pathological mechanisms and improving the diagnostic and management protocols in childhood arterial ischemic stroke. However, childhood stroke comprises, in approximately equal parts, both arterial ischemic and hemorrhagic stroke.

Objective: The aim of this study was to focus on the etiology, clinical presentation, treatment, and short-term outcome of children with spontaneous intracranial bleeding in a university hospital and elucidate differences to childhood arterial ischemic stroke.

Method: We performed a retrospective analysis of electronic medical records of children (28 days–18 years) diagnosed with hemorrhagic stroke between January 2010 and December 2016. Hemorrhagic stroke was defined as spontaneous, nontraumatic intracranial bleeding which could be intraparenchymal, subarachnoid, or intraventricular.

Results: We included 25 children (male n = 11) with a median age of 8 years 1 month (range: 1 month–16 years 9 month). The most common clinical presentations were vomiting (48%), headache (40%), and altered level of consciousness (32%). In more than half of the patients hemorrhagic stroke was caused by vascular malformations (arteriovenous malformations n = 6, cavernoma n = 7), although these did not present in infants in the first year of life. Other risk factors were brain tumor (n = 5), coagulopathy (n = 2), encephalitis (n = 1) hemato-oncological diseases (n = 2), and a severe chronic lung disease with multiorgan failure (n = 1). Etiology remained unclear in one child. Therapy was neurosurgical (n = 17), endovascular (n = 1), or conservative (n = 7). Two patients died, both with a complicated course of a severe underlying disease. Five patients needed further (rehabilitation) treatment and 18 children could be discharged home.

Conclusion: Hemorrhagic stroke differs in etiology (vascular malformations as number 1 risk factor), number of risk factors (“mono-risk” disease), clinical presentation (vomiting, headache, and altered level of consciousness) and (emergency) therapy. A first step for further comparable cohort studies should be a clear definition of hemorrhagic stroke in the pediatric population and a consistent use of ICD-10 coding.

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