Hematomas intraparenquimatosos sin causa aparente en pediatría / Intraparenchimatous hematomas without apparent etiology in pediatrics

ABSTRACT

Objetive spontaneous intracerebral hemorrhage (ICH) in pediatric population has many causes. Some patients remain non diagnosed in spite of being fully checked. Our objective is to analyze those patients whose etiology could not be found. Material and method: from march 2006 to april 2009 we studied 39 patients with ICH. Trauma and coagulation disorders were excluded. CT scan was performed to diagnose the bleeding. MRI and al least two digital subtraction angiography (DSA) were the methods of diagnosis. Results: thirty-nine presented ICH. Twenty presented AVM, five aneurysm, one tumor, three dural sinus thrombosis. In 4 females and 6 male (age 2 months to 12 years) no etiology could be found. Six patients had headache, four sensory loss and two seizures. The cerebellar hemisphere was involved in two patients, basal ganglia in two, thalamus in one and five were subcortical located. Six presented intraventricular hemorrhage , and needed extremal ventricular drainage. Six patients underwent clot removal because of mass effect. All patients survived. Four remained with hemiparesia. Conclusion: in 25% of patients with ICH no etiology could be found in spite of being fully checked. The majority of them were between 6 a12 years old. There were no children over 12 years. There were no deaths in this serie; therefore early surgery due to increased ICP seems to have a favorable outcome.