title: Intracranial hemorrhage in children: an evolving spectrum.
abstract: BACKGROUND
  Nontraumatic intracranial hemorrhages (ICHs) are uncommon in children, but are important causes of death and injury.
  
  
  OBJECTIVE
  To determine whether the risk factors for ICH have changed compared with those in earlier published series and to estimate the residual deficits in the survivors.
  
  
  METHODS
  We performed a retrospective review of patients admitted to a single tertiary care, academic pediatric hospital from January 1, 2000, through May 31, 2007. Records were retrieved if the diagnostic codes from the International Classification of Diseases, Ninth Revision, were pertinent to ICHs. We searched reports from computed tomograms and magnetic resonance images of the brain for terms pertaining to ICH.
  
  
  METHODS
  Risk factors and functional outcome. Secondary measures were hemorrhage type and clinical presentation.
  
  
  RESULTS
  We identified 85 children who had nontraumatic ICH. There were 10 subarachnoid, 61 intracerebral, and 14 subdural hemorrhages. Intracranial vascular anomalies were the most frequent risk factor, followed by congenital heart disease and brain tumors. Arteriovenous malformations did not account for as large a percentage as in previous studies. Twenty-nine children died. Of the 48 survivors for whom follow-up information was available, 26 had no reported deficits and 22 had deficits ranging from mild to severe.
  
  
  CONCLUSIONS
  In this series, brain tumors and congenital heart disease accounted for a greater proportion of ICHs than in previous studies. The mortality due to ICH remains high but may be related as much to the severity of the underlying illnesses as to the hemorrhage itself. We found significant long-term morbidity, but more than half of the survivors for whom follow-up data were available had no detectable deficits. A long-term outcome study of pediatric ICH is needed.
authors.affiliation: Department of Pediatrics, The Ohio State University, Nationwide Children's Hospital, Room EDU 533, 700 Children's Dr, Columbus, OH 43205-2654, USA. warren.lo@nationwidechildrens.org
authors.forename: Warren D
authors.initials: WD
authors.lastname: Lo
authors.forename: JoEllen
authors.initials: J
authors.lastname: Lee
authors.forename: Jerome
authors.initials: J
authors.lastname: Rusin
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Perkins
authors.forename: E Steve
authors.initials: ES
authors.lastname: Roach
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001932:Brain Neoplasms / Q000150:complications; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D006331:Heart Diseases; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D020300:Intracranial Hemorrhages / Q000150:complications* / Q000209:etiology* / Q000401:mortality; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors