Hemorrhagic stroke in children
- Evelyn Shih, MD, PhD
Evelyn Shih, MD, PhD
- Fellow Physician, Division of Neurology
- The Children's Hospital of Philadelphia
- Lauren Beslow, MD, MSCE
Lauren Beslow, MD, MSCE
- Assistant Professor of Pediatrics and Neurology
- Director, Pediatric and Neonatal Stroke Program
- Yale School of Medicine
- Section Editors
- Scott E Kasner, MD
Scott E Kasner, MD
- Section Editor — Stroke
- Professor of Neurology
- University of Pennsylvania School of Medicine
- Douglas R Nordli, Jr, MD
Douglas R Nordli, Jr, MD
- Section Editor — Pediatric Neurology
- Chief of Neurology
- Children’s Hospital Los Angeles
- Vice Chair of Neurology
- USC Keck School of Medicine
Although less common than in adults, hemorrhagic stroke can affect children, resulting in significant morbidity and mortality.
An overview of hemorrhagic stroke in children beyond the newborn period is provided here. Other clinical aspects of stroke in neonates and children are reviewed elsewhere. (See "Stroke in the newborn" and "Ischemic stroke in children and young adults: Etiology and clinical features" and "Ischemic stroke in children: Evaluation, initial management, and prognosis" and "Ischemic stroke in children: Secondary prevention" and "Etiology, clinical features, and diagnosis of cerebral venous thrombosis".)
Hemorrhagic stroke encompasses spontaneous intracerebral hemorrhage, isolated intraventricular hemorrhage, and nontraumatic subarachnoid hemorrhage . Intracerebral hemorrhage is defined by intraparenchymal hemorrhage or a combination of intraparenchymal and intraventricular hemorrhage (image 1).
Despite its common usage, the term hemorrhagic stroke remains confusing. It has been used to denote hemorrhagic transformation of arterial ischemic stroke or of cerebral venous sinus thrombosis, but it does not encompass those entities, strictly speaking.
Although stroke in children is relatively rare compared with adults, it is a significant cause of childhood death and lifelong disability. A stroke suffered within the first decade may cause functional sequelae for multiple decades to follow. Hemorrhagic stroke is a notable contributor to childhood morbidity and mortality, as it accounts for about half of all childhood strokes, compared with <20 percent of adult strokes [2,3].
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- ETIOLOGY AND RISK FACTORS
- Vascular malformations
- CLINICAL FEATURES AND PRESENTATION
- INITIAL EVALUATION AND DIAGNOSIS
- Urgent neuroimaging
- Laboratory studies
- DIFFERENTIAL DIAGNOSIS
- Supportive measures
- Intracranial pressure
- Identifying the etiology
- Treatment of vascular lesions
- Follow-up imaging
- Neurologic outcome
- Outcome predictors
- Hemorrhagic stroke recurrence
- SUMMARY AND RECOMMENDATIONS