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. 2010 Feb;41(2):313-8.
doi: 10.1161/STROKEAHA.109.568071. Epub 2009 Dec 17.

Predictors of outcome in childhood intracerebral hemorrhage: a prospective consecutive cohort study

Lauren A Beslow  1 , Daniel J Licht, Sabrina E Smith, Phillip B Storm, Gregory G Heuer, Robert A Zimmerman, Alana M Feiler, Scott E Kasner, Rebecca N Ichord, Lori C Jordan
Affiliations

Predictors of outcome in childhood intracerebral hemorrhage: a prospective consecutive cohort study

Lauren A Beslow et al. Stroke. 2010 Feb.

Abstract

Background and purpose: The purposes of this study were to describe features of children with intracerebral hemorrhage (ICH) and to determine predictors of short-term outcome in a single-center prospective cohort study.

Methods: A single-center prospective consecutive cohort study was conducted of spontaneous ICH in children aged 1 to 18 years from January 2006 to June 2008. Exclusion criteria were inciting trauma; intracranial tumor; isolated epidural, subdural, intraventricular, or subarachnoid hemorrhage; hemorrhagic transformation of ischemic stroke; and cerebral sinovenous thrombosis. Hospitalization records were abstracted. Follow-up assessments included outcome scores using the Pediatric Stroke Outcome Measure and King's Outcome Scale for Childhood Head Injury. ICH volumes and total brain volumes were measured by manual tracing.

Results: Twenty-two patients, median age 10.3 years (range, 4.2 to 16.6 years), had presenting symptoms of headache in 77%, focal deficits 50%, altered mental status 50%, and seizures 41%. Vascular malformations caused hemorrhage in 91%. Surgical treatment (hematoma evacuation, lesion embolization or excision) was performed during acute hospitalization in 50%. One patient died acutely. At a median follow-up of 3.5 months (range, 0.3 to 7.5 months), 71% of survivors had neurological deficits; 55% had clinically significant disability. Outcome based on Pediatric Stroke Outcome Measure and King's Outcome Scale for Childhood Head Injury scores was worse in patients with ICH volume >2% of total brain volume (P=0.023) and altered mental status at presentation (P=0.005).

Conclusions: Spontaneous childhood ICH was due mostly to vascular malformations. Acute surgical intervention was commonly performed. Although death was rare, 71% of survivors had persisting neurological deficits. Larger ICH volume and altered mental status predicted clinically significant disability.

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Conflict of interest statement

None of the authors has any conflict of interest or disclosures.

Figures

Figure 1
Figure 1
Neurological Deficits at Follow-up, N = 21
Figure 2
Figure 2
King's Outcome Scale for Childhood Head Injury (KOSCHI), dark vertical line represents cut-off between good and poor outcomes
Figure 3
Figure 3
Example Head Computed Tomography A, Intracerebral hemorrhage (ICH) 0.69% of total brain volume (TBV); B, ICH 2.8%TBV; C, ICH 6.93%TBV
See this image and copyright information in PMC

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