Recurrent hemorrhagic stroke in children: a population-based cohort study.
OBJECTIVE
Although hemorrhagic strokes (HS) account for half of all strokes in children, rates and predictors of recurrent HS have not been studied.


METHODS
We collected data on all documented cases of HS (intracerebral hemorrhage, subarachnoid hemorrhage, and intraventricular hemorrhage, except neonatal intraventricular hemorrhage), among 2.3 million children (<20 years) enrolled in a Northern Californian health maintenance organization from January 1993 to December 2004. Using Kaplan-Meier survival analyses censoring at death or loss to follow-up, we determined rates of recurrent HS. Log rank tests were used for bivariate comparisons.


RESULTS
Among 116 children with atraumatic incident HS followed for a mean of 4.2 years, 11 had a recurrent HS at a median of 3.1 months (range 7 days to 5.7 years), yielding an overall 5-year cumulative recurrence rate (CRR) of 10% (95% CI, 58% to 18%). Sixty-four percent of recurrences were within the first 6 months. Whereas children with idiopathic HS (n=29) had no recurrences, children with structural lesions (vascular malformations or tumors) had a 5-year cumulative recurrence rate of 13% (95% CI, 7% to 25%; 9 recurrences among 71 children; P<0.05 compared with idiopathic). Children with medical etiologies (eg, thrombocytopenia, hypertension) had a 5-year cumulative recurrence rate of 13% (95% CI, 3% to 41%; 2 recurrences among 16 children), but the recurrences were within the first week.


CONCLUSIONS
Overall, 1 in 10 children with HS experienced a recurrence within 5 years, despite available therapies. Whereas idiopathic HS rarely recurred, and HS due to medical etiologies tended to recur acutely, children with structural lesions had a high and prolonged risk for recurrence.
Fullerton
Heather J
HJ
Department of Neurology, University of California, San Francisco, Box 0114, San Francisco, CA 94143-0114, USA. fullertonh@neuropeds.ucsf.edu
Wu
Yvonne W
YW
Sidney
Stephen
S
Johnston
S Claiborne
SC
D000293:Adolescent; D002543:Cerebral Hemorrhage / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D002648:Child; D015331:Cohort Studies; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery