BACKGROUND AND PURPOSE: Prior population-based studies of pediatric hemorrhagic stroke (HS) had too few incident cases to assess predictors of cerebral aneurysms, a HS etiology that requires urgent intervention. METHODS: We performed a retrospective cohort study of HS (intracerebral, subarachnoid [SAH], and intraventricular hemorrhage) using the population of all children <20 years of age enrolled in a large Northern Californian healthcare plan (January 1993 to December 2003). Cases were identified through electronic searches and confirmed through independent chart review by 2 neurologists with adjudication by a third; traumatic hemorrhages were excluded. Logistic regression was used to examine potential predictors of underlying aneurysm. RESULTS: Within a cohort of 2.3 million children followed for a mean of 3.5 years, we identified 116 cases of spontaneous HS (overall incidence, 1.4 per 100000 person-years). Cerebral aneurysms were identified in 15 (13%) of HS cases. Among 21 children with pure SAH, 57% were found to have an underlying aneurysm compared with only 2% of 58 children with pure intracerebral hemorrhage and 5% of 37 children with a mixed pattern of hemorrhage (intracerebral hemorrhage and SAH). Independent predictors of an underlying aneurysm included pure SAH (OR, 76; 95% CI, 9 to 657; P<0.001) and late adolescent age (15 to 19 years versus younger age groups; OR, 6.4; 95% CI, 1.0 to 40; P=0.047). CONCLUSIONS: Cerebral aneurysms cause the majority of spontaneous SAH in children and account for more than 10% of childhood HS overall. Children, and particularly teenagers, presenting with spontaneous SAH should be promptly evaluated with cerebrovascular imaging.
BACKGROUND AND PURPOSE: Prior population-based studies of pediatric hemorrhagic stroke (HS) had too few incident cases to assess predictors of cerebral aneurysms, a HS etiology that requires urgent intervention. METHODS: We performed a retrospective cohort study of HS (intracerebral, subarachnoid [SAH], and intraventricular hemorrhage) using the population of all children <20 years of age enrolled in a large Northern Californian healthcare plan (January 1993 to December 2003). Cases were identified through electronic searches and confirmed through independent chart review by 2 neurologists with adjudication by a third; traumatic hemorrhages were excluded. Logistic regression was used to examine potential predictors of underlying aneurysm. RESULTS: Within a cohort of 2.3 million children followed for a mean of 3.5 years, we identified 116 cases of spontaneous HS (overall incidence, 1.4 per 100000 person-years). Cerebral aneurysms were identified in 15 (13%) of HS cases. Among 21 children with pure SAH, 57% were found to have an underlying aneurysm compared with only 2% of 58 children with pure intracerebral hemorrhage and 5% of 37 children with a mixed pattern of hemorrhage (intracerebral hemorrhage and SAH). Independent predictors of an underlying aneurysm included pure SAH (OR, 76; 95% CI, 9 to 657; P<0.001) and late adolescent age (15 to 19 years versus younger age groups; OR, 6.4; 95% CI, 1.0 to 40; P=0.047). CONCLUSIONS:Cerebral aneurysms cause the majority of spontaneous SAH in children and account for more than 10% of childhood HS overall. Children, and particularly teenagers, presenting with spontaneous SAH should be promptly evaluated with cerebrovascular imaging.
Authors: Heather J Fullerton; Achal S Achrol; S Claiborne Johnston; Charles E McCulloch; Randall T Higashida; Michael T Lawton; Stephen Sidney; William L Young Journal: Stroke Date: 2005-09-01 Impact factor: 7.914
Authors: Jonathan T Kleinman; Lauren A Beslow; Kyle Engelmann; Sabrina E Smith; Daniel J Licht; Rebecca N Ichord; Lori C Jordan Journal: J Child Neurol Date: 2011-11-08 Impact factor: 1.987
Authors: Lauren A Beslow; Rebecca N Ichord; Melissa C Gindville; Jonathan T Kleinman; Kyle Engelmann; Rachel A Bastian; Daniel J Licht; Sabrina E Smith; Argye E Hillis; Lori C Jordan Journal: Stroke Date: 2013-11-26 Impact factor: 7.914
Authors: Christine K Fox; Hannah C Glass; Stephen Sidney; Daniel H Lowenstein; Heather J Fullerton Journal: Ann Neurol Date: 2013-08 Impact factor: 10.422
Authors: Lauren A Beslow; Rebecca N Ichord; Melissa C Gindville; Jonathan T Kleinman; Rachel A Bastian; Sabrina E Smith; Daniel J Licht; Argye E Hillis; Lori C Jordan Journal: JAMA Neurol Date: 2014-02 Impact factor: 18.302