Intracerebral hemorrhage in children

Introduction: Intracerebral hemorrhage (ICH) in children is relatively less common as compared to adults. It could be traumatic or spontaneous. Objective: There are limited studies about ICH in children. In this study, we analyze the etiology, clinical features, management options and outcome assessment in this population. Methods: All patients with intracerebral hemorrhage under 18 years of age admitted to the neurosurgery department; Alexandria University Main Hospital and Medical Research Institute over a period of one year (June 2008–May 2009) were subjected to clinical examination, laboratory and radiological investigations and the cause of hemorrhage was determined. Results: Thirty patients with ICH were included in this study. Age of patients ranged from one month to 17.5 years with a higher predilection in males. Presenting features were symptoms of raised intracranial pressure (60%), deterioration in sensorium (46%), limb weakness (36%) and seizures (30.0%). Trauma was the most common cause of ICH and was found in 13 patients (43%), followed by bleeding diathesis in nine patients (30%), arteriovenous malformation (AVM) in five patients (17%), intracranial tumor in two patients and an aneurysm in one patient. Treatment modalities consisted of: hematoma evacuation, excision of AVM, AVM emobilization, aneurysm clipping, tumor excision, and conservative management. Eleven patients were treated conservatively and 19 patients were treated surgically. The outcome showed: good recovery in 14(47%), fair recovery in seven (23%), poor recovery in seven (23%), and death in two patients (7%). Conclusions: Trauma is the leading cause of ICH in children. Bleeding diathesis and AVM come next. The initial neurological status of patients, the size, location and underlying pathophysiology of the hematoma are the most important determinants of patient outcome. Intracerebral hemorrhage due to bleeding diathesis was generally associated with a better outcome.