Pediatric hemorrhagic stroke: A retrospective case series in Hong Kong

Abstract

Background: Non-traumatic paediatric haemorrhagic stroke (PHS) is a common cause of death in children. We aimed to delineate the aetiologies of PHS and compare the outcomes of various management approaches to improve the treatment for children with PHS. Methods: A retrospective analysis of PHS patients from a tertiary neurosurgical centre was conducted. Outcomes were evaluated based on the 30-day complication rate, rebleeding rate and functional outcome using the Modified Rankin Scale. Results: 39 patients were identified. The most common presentation for older children was severe headache, whereas symptoms were non-specific in younger children. Structural vascular lesions are the most common cause of PHS and 46% had arteriovenous malformation. 56% of patients received acute surgical intervention. 47% of patients were treated conservatively in the acute setting requiring interval definitive surgeries. Surgically managed patients experienced a higher 30-day complication rate but lower rebleeding rate. Functional outcome is good for PHS and most patients had full recovery. Conclusions: Ruptured cerebral arteriovenous malformation was the most common cause of PHS and sudden onset of severe headache was the key presenting symptom. Prompt surgical intervention for PHS reduced the rebleeding rate.

Keywords

• Paediatric stroke
• Haemorrhagic stroke
• Intracerebral haemorrhage
• Intraventricular haemorrhage
• Subarachnoid haemorrhage
• Neurosurgery