Background: In the pediatric population, symptomatic nontraumatic intracranial hemorrhage (ICH) is a rarely encountered condition, yet with often very serious implications. It can result from a wide spectrum of intracranial and systemic causes. Knowledge of disease etiology is important for planning treatment and follow-up strategy. The aim of the present study was to characterize the spectrum and age dependence of the underlying causes of acute spontaneous ICH in children and adolescents from a single-center cohort.
Methods: During the period 2011-2021, we identified all pediatric patients aged from 1 month to 18 years (included) who were undergoing diagnostic neuroimaging at Copenhagen University Hospital Rigshospitalet, Denmark, and who presented with acute spontaneous ICH on diagnostic neuroimaging. Data on the underlying cause of hemorrhage were retrospectively extracted from neuroimaging records and medical files. A possible association of hemorrhage causes with patient age was investigated using the Fisher-Freeman-Halton exact test and the Fisher exact test.
Results: Ninety-one patients with acute ICH were identified. The most common cause was arteriovenous malformation (AVM, N=29, 31.9%). Overall, patient age and cause of ICH varied statistically significantly (P < 0.001). Acute hemorrhage in patients younger than six years was less likely caused by AVM (P < 0.001) and more likely by treatment-related conditions (P = 0.01).
Conclusions: This is the first observational retrospective study analyzing the causes of acute ICH in the pediatric population in Denmark. The most common cause was AVM, and we found significant association between AVMs and treatment-related hemorrhages with age.
Keywords: Childhood stroke; Hemorrhagic stroke; Intracranial hemorrhage; Pediatric stroke; Spontaneous intracranial hemorrhage.
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