Abstract
Hemorrhagic strokes account for half of all strokes seen in children, and the etiologies of these hemorrhagic strokes differ greatly from those seen in adult patients. This review gives an overview about incidence and etiologies as well as presentation of children with intracerebral hemorrhage and with differential diagnoses in the emergency department. Most importantly it describes how neuroimaging of children with intracerebral hemorrhage should be tailored to specific situations and clinical contexts and recommends specific imaging protocols for acute and repeat imaging. In this context it is important to keep in mind the high prevalence of underlying vascular lesions and adapt the imaging protocol accordingly, meaning that vascular imaging plays a key role regardless of modality. Magnetic resonance imaging (MRI), including advanced sequences, should be favored whenever possible at the acute phase.
Highlights
While accounting for a minority of adult strokes, hemorrhagic strokes account for half of all strokes seen in children, and occur in approximately 1–2 per 100,000 children per year [1,2]
The etiologies of hemorrhagic stroke differ in children as well; hypertensive hemorrhage rarely occurs in children, and cerebral amyloid angiopathy is almost exclusively an adult disease [3]
Patterns of hemorrhage can provide a clue to etiology—a child with an intracerebral hemorrhage (ICH) extending into the ventricles or subarachnoid space most likely has a brain arteriovenous malformation (AVM), a child with a pure ICH has about an equal chance of an AVM or cavernous malformation [4]
Summary
While accounting for a minority of adult strokes, hemorrhagic strokes account for half of all strokes seen in children, and occur in approximately 1–2 per 100,000 children per year [1,2]. The etiologies of hemorrhagic stroke differ in children as well; hypertensive hemorrhage rarely occurs in children, and cerebral amyloid angiopathy is almost exclusively an adult disease [3]. Trauma is the most common cause of intracerebral hemorrhage (ICH) in children, and the distinction between traumatic versus spontaneous hemorrhage can be challenging. Spontaneous ICH in children is most often caused by an underlying structural lesion, most often a congenital vascular malformation. Cerebral aneurysms rarely cause intraparenchymal hemorrhage, but are the most common cause of pure subarachnoid hemorrhage, even in children. While most AVMs lesions in children are spontaneous, features suggesting an underlying genetic syndrome include multiple AVMs, AVMs in unusual locations (e.g., spinal), and vascular birthmarks, in addition to a positive family history (autosomal dominant inheritance pattern) [6]. We describe how neuroimaging of children with intracerebral hemorrhage should be tailored to specific situations and clinical contexts and recommend specific imaging protocols for acute and repeat imaging
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call