title: The importance of cerebral aneurysms in childhood hemorrhagic stroke: a population-based study.
abstract: OBJECTIVE
  Prior population-based studies of pediatric hemorrhagic stroke (HS) had too few incident cases to assess predictors of cerebral aneurysms, a HS etiology that requires urgent intervention.
  
  
  METHODS
  We performed a retrospective cohort study of HS (intracerebral, subarachnoid [SAH], and intraventricular hemorrhage) using the population of all children <20 years of age enrolled in a large Northern Californian healthcare plan (January 1993 to December 2003). Cases were identified through electronic searches and confirmed through independent chart review by 2 neurologists with adjudication by a third; traumatic hemorrhages were excluded. Logistic regression was used to examine potential predictors of underlying aneurysm.
  
  
  RESULTS
  Within a cohort of 2.3 million children followed for a mean of 3.5 years, we identified 116 cases of spontaneous HS (overall incidence, 1.4 per 100000 person-years). Cerebral aneurysms were identified in 15 (13%) of HS cases. Among 21 children with pure SAH, 57% were found to have an underlying aneurysm compared with only 2% of 58 children with pure intracerebral hemorrhage and 5% of 37 children with a mixed pattern of hemorrhage (intracerebral hemorrhage and SAH). Independent predictors of an underlying aneurysm included pure SAH (OR, 76; 95% CI, 9 to 657; P<0.001) and late adolescent age (15 to 19 years versus younger age groups; OR, 6.4; 95% CI, 1.0 to 40; P=0.047).
  
  
  CONCLUSIONS
  Cerebral aneurysms cause the majority of spontaneous SAH in children and account for more than 10% of childhood HS overall. Children, and particularly teenagers, presenting with spontaneous SAH should be promptly evaluated with cerebrovascular imaging.
authors.affiliation: Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Lori C
authors.initials: LC
authors.lastname: Jordan
authors.forename: S Claiborne
authors.initials: SC
authors.lastname: Johnston
authors.forename: Yvonne W
authors.initials: YW
authors.lastname: Wu
authors.forename: Stephen
authors.initials: S
authors.lastname: Sidney
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Fullerton
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D002140:California; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000150:complications* / Q000453:epidemiology* / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D002532:Intracranial Aneurysm / Q000150:complications* / Q000453:epidemiology*; D016015:Logistic Models; D018810:Magnetic Resonance Angiography; D008297:Male; D011153:Population; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology*; D013345:Subarachnoid Hemorrhage / Q000453:epidemiology / Q000209:etiology; D055815:Young Adult