Document Detail

Incidence of vascular malformations in spontaneous intra-cerebral haemorrhage in children.
MedLine Citation:
PMID:  17450369     Owner:  NLM     Status:  MEDLINE    
AIM: To assess the incidence of vascular malformations in children presenting with non-traumatic intra-cerebral haemorrhage and outline the need for radiological investigations. MATERIALS AND METHODS: Between 1993 and 2002, 26 children presented with spontaneous intra-cerebral haemorrhage at a mean age of 26 months (range 1-192 months). RESULTS: Twenty-two children had, as first treatment, surgical removal of the haematoma and any malformation found. One patient with no evidence of vascular malformation had conservative treatment, two had embolisation and one had stereotactic radiosurgery of arteriovenous malformations (AVMs). The diagnosis of vascular malformation was confirmed histologically and/or radiologically in 16 (61%) patients. Of these 16 patients, 7 were AVMs, 1 thrombosed middle cerebral artery (MCA) aneurysm, 1 cavernous angioma, 6 aggregates of abnormal vessels, 1 vein of Galen aneurysm. Pre-operatively, 12 patients had magnetic resonance imaging (MRI)/magnetic resonance angiography (MRA) and 7 were positive for vascular malformation (1 false positive) with no false negatives. Digital subtraction angiography (DSA) was performed pre-operatively in 7 patients, 4 were positive with no false negatives. There were no re-bleeds at the follow-up period. Five (19%) patients died from the haemorrhage, 7 (27%) had severe neurological deficit and 14 (54%) had no neurological deficit. Residual malformation after surgery requiring additional treatment was found in 3 (16%) patients. All patients with confirmed malformations were followed-up with DSA. CONCLUSION: MRI/MRA has high sensitivity and specificity in identifying vascular malformations in children presenting acutely with spontaneous intra-cerebral haemorrhage. This may prove useful when pre-operative DSA is not promptly available. After acute clot evacuation, there is high incidence of residual malformation and such patients should be followed-up with DSA.
A Papadias; A Taha; S Sgouros; A R Walsh; A D Hockley
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Publication Detail:
Type:  Journal Article     Date:  2007-04-21
Journal Detail:
Title:  Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery     Volume:  23     ISSN:  0256-7040     ISO Abbreviation:  Childs Nerv Syst     Publication Date:  2007 Aug 
Date Detail:
Created Date:  2007-06-27     Completed Date:  2007-11-20     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8503227     Medline TA:  Childs Nerv Syst     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  881-6     Citation Subset:  IM    
Department of Paediatric Neurosurgery, Birmingham Children's Hospital, Steelhouse Lane, B4 6NH, Birmingham, UK.
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MeSH Terms
Angiography, Digital Subtraction
Cerebral Hemorrhage / epidemiology*,  pathology,  radiography
Child, Preschool
Intracranial Arteriovenous Malformations / epidemiology*,  pathology,  radiography
Magnetic Resonance Imaging
Neurosurgical Procedures
Retrospective Studies
Seizures / etiology
Tomography, X-Ray Computed
Treatment Outcome
Unconsciousness / etiology

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