title: [Cerebrovascular accidents in paediatric care. Our experience gained over an 18-year period].
abstract: METHODS
  This study reviews our experience over the last 18 years with paediatric patients diagnosed with non-haemorrhagic cerebrovascular accidents (CVA) after the perinatal period. Data were collected for the period between May 1990 and May 2008 (n = 10 270 children) and special attention was given to cases with no previous pathology.
  
  
  RESULTS
  We found 41 cases that were diagnosed with post-natal non-haemorrhagic CVA, of which 13 did not present any known pathology at the onset of the symptoms. Nine patients were diagnosed as having ischaemic CVA (ICVA), three cases had thrombosis of the venous sinuses and there was one case of haemorrhagic infarction (HI). No causation was found in five cases, three of which were heterozygotic for the C677T mutation of methylenetetrahydrofolate reductase. ICVA was caused by fibromuscular dysplasia, aneurysm of the auricular septum and patent foramen ovale, homocystinuria and chickenpox. A recent ear infection and diminished levels of protein C were noted in two cases of venous thrombosis. Five patients with ICVA and the case of HI were treated with oral antiaggregants, anticoagulants were administered in two of the thromboses, and the remaining cases did not receive any treatment. Seven patients (four ICVA, two thromboses and the HI) did not present any kind of sequelae, four ICVA presented different degrees of hemiparesis and two died (one ICVA and one thrombosis).
  
  
  CONCLUSIONS
  The scarcity of studies and therapeutic clinical trials in the paediatric age makes it difficult to lay down clear guidelines of conduct, especially from the therapeutic point of view. The different specialists involved must collaborate with each other.
authors.affiliation: Unidad de Neuropediatría, Hospital Universitario Miguel Servet, 50009 Zaragoza, España.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Ruiz del Olmo-Izuzquiza
authors.forename: Antonio
authors.initials: A
authors.lastname: de Arriba-Muñoz
authors.forename: Javier
authors.initials: J
authors.lastname: López-Pisón
authors.forename: Juan Pablo
authors.initials: JP
authors.lastname: García-Iñiguez
authors.forename: Ruth
authors.initials: R
authors.lastname: Romero-Gil
authors.forename: Lorena
authors.initials: L
authors.lastname: Monge-Galindo
authors.forename: Raquel
authors.initials: R
authors.lastname: Pérez-Delgado
authors.forename: José Luis
authors.initials: JL
authors.lastname: Peña-Segura
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D042965:Methylenetetrahydrofolate Reductase (NADPH2) / Q000235:genetics; D010372:Pediatrics; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology / Q000503:physiopathology
chemical_list: D042965:Methylenetetrahydrofolate Reductase (NADPH2)