Perte de connaissance après un traumatisme minime révélant une rupture d’anévrisme chez un enfant

Abstract

In pediatrics, concussions are common after falls and are often banal. However, it is important to identify situations where a particular inquiry is essential. Cerebral hemorrhage and aneurysms, although more common in adults, can also occur the young. The best investigation for diagnosis is the brain CT scan. After a soccer head injury, a 13-year-old boy presented with headache, abdominal pain, and a feeling of being ill. Then, he quickly lost consciousness and had amnesia for several hours. On arrival, the clinical examination, including neurological testing was normal except for bradycardia and pallor. He then presented a severe meningeal syndrome. A CT scan showed cerebral hemorrhage at the left sylvian fissure and in the posterior fossa. MR angiography confirmed subarachnoid hemorrhage and made and us suspect an aneurismal lesion in the emergence of the left sylvian artery. Cerebral hemorrhage is rare in children (about 1.4/10,0000 per year), 18% of which are pure meningeal forms. In the cases of intraventricular or subarachnoid hemorrhage in children, it is essential to complete the assessment by angiography because the risk of underlying aneurysm is then 57%. Among children with aneurysm, 35% will have bleeding from aneurysm rupture, especially during adolescence. Cerebral aneurysms are usually not familial. A family screening should only be performed when two cases or more of intracerebral aneurysms are reported in first- or second-degree relatives. In this case, the best investigation is cerebral MR angiography.