Predictors of outcome in childhood intracerebral hemorrhage: a prospective consecutive cohort study.
OBJECTIVE
The purposes of this study were to describe features of children with intracerebral hemorrhage (ICH) and to determine predictors of short-term outcome in a single-center prospective cohort study.


METHODS
A single-center prospective consecutive cohort study was conducted of spontaneous ICH in children aged 1 to 18 years from January 2006 to June 2008. Exclusion criteria were inciting trauma; intracranial tumor; isolated epidural, subdural, intraventricular, or subarachnoid hemorrhage; hemorrhagic transformation of ischemic stroke; and cerebral sinovenous thrombosis. Hospitalization records were abstracted. Follow-up assessments included outcome scores using the Pediatric Stroke Outcome Measure and King's Outcome Scale for Childhood Head Injury. ICH volumes and total brain volumes were measured by manual tracing.


RESULTS
Twenty-two patients, median age 10.3 years (range, 4.2 to 16.6 years), had presenting symptoms of headache in 77%, focal deficits 50%, altered mental status 50%, and seizures 41%. Vascular malformations caused hemorrhage in 91%. Surgical treatment (hematoma evacuation, lesion embolization or excision) was performed during acute hospitalization in 50%. One patient died acutely. At a median follow-up of 3.5 months (range, 0.3 to 7.5 months), 71% of survivors had neurological deficits; 55% had clinically significant disability. Outcome based on Pediatric Stroke Outcome Measure and King's Outcome Scale for Childhood Head Injury scores was worse in patients with ICH volume >2% of total brain volume (P=0.023) and altered mental status at presentation (P=0.005).


CONCLUSIONS
Spontaneous childhood ICH was due mostly to vascular malformations. Acute surgical intervention was commonly performed. Although death was rare, 71% of survivors had persisting neurological deficits. Larger ICH volume and altered mental status predicted clinically significant disability.
Beslow
Lauren A
LA
Division of Neurology, 6th Floor, Wood Building, The Children's Hospital of Philadelphia, Philadelphia, Pa 19104, USA. beslow@email.chop.edu
Licht
Daniel J
DJ
Smith
Sabrina E
SE
Storm
Phillip B
PB
Heuer
Gregory G
GG
Zimmerman
Robert A
RA
Feiler
Alana M
AM
Kasner
Scott E
SE
Ichord
Rebecca N
RN
Jordan
Lori C
LC
D000293:Adolescent; D001921:Brain / Q000098:blood supply / Q000473:pathology* / Q000601:surgery; D001925:Brain Damage, Chronic / Q000453:epidemiology; D020785:Central Nervous System Vascular Malformations / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D002536:Cerebral Arteries / Q000002:abnormalities / Q000473:pathology* / Q000601:surgery; D002543:Cerebral Hemorrhage / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D009026:Mortality; D019635:Neurosurgical Procedures / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index