G121(P) Spontaneous haemorrhagic stroke and cerebral arteriovenous malformations and aneurysms in children

IntroductionWith an incidence of 1/100,000 children, haemorrhagic stroke may be rare in the child population but it is still one of the top ten causes of death in childhood.There are few data about spontaneous haemorrhagic stroke in children in the UK. This retrospective study analyses the clinical presentation, relative frequency of various types of haemorrhage, prevalence of vascular abnormalities and outcome in haemorrhagic stroke spanning a 10 year period from 2005–2015 in 104 children seen at a teaching hospital serving a defined population. This service evaluation will give an insight into the epidemiology and long-term outcome of childhood haemorrhagic stroke in children within the UK.MethodPatients were ascertained for this study by reviewing medical records for key words relating to haemorrhagic stroke: intracranial haemorrhage, subarachnoid haemorrhage, arteriovenous malformation and aneurysm. They were included if they had been diagnosed under the age of 21 with a vascular abnormality predisposing to haemorrhage or if they had suffered haemorrhage or not. Patients that had suffered a traumatic haemorrhage were excluded.ResultsThere were 104 patients, 61 (59%) boys median age 11.6 (range 0 to 21) years. Clinical presentations showed symptoms including headaches (46.2%), vomiting (23.1%), collapse (16.3%). 51.9% of patients were diagnosed with an intracerebral haematoma and those that suffered a subarachnoid haemorrhage was 9.6%. Of those patients that bled, the commonest cause of haemorrhage was arteriovenous malformation (42.9%) followed by arterial aneurysm (11.9%) and cavernous malformation (7.3%). There were 3 deaths (2.9%) at 1 day, 4 months and 5 years post presentation. Of the survivors, there was no recurrence of haemorrhage over a median follow-up of 1.5 (range 0–10) years.ConclusionComplementary to studies of ischaemic stroke, haemorrhagic stroke was commoner in boys. Similarly intracerebral was the most common diagnosis, the most common cause being arteriovenous malformations, while we did not confirm the relatively high prevalence of aneurysms found in Californian children. Mortality and recurrence rate for this hospitalised population were low. The results for clinical presentations were lower than similar studies, probably because we included patients with all predisposing vascular abnormalities whether or not the patient presented with haemorrhage.