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(Stroke. 2007;38:2658.)
© 2007 American Heart Association, Inc.

Original Contributions

Recurrent Hemorrhagic Stroke in Children

A Population-Based Cohort Study

Heather J. Fullerton, MD, MAS; Yvonne W. Wu, MD, MPH; Stephen Sidney, MD, MPH S. Claiborne Johnston, MD, PhD

From the Departments of Neurology (H.J.F., Y.W.W., S.C.J.), Pediatrics (H.J.F., Y.W.W.), and Epidemiology (S.C.J.), University of California, San Francisco; and the Division of Research, Kaiser Permanente Medical Care Program (S.S.), Oakland, Calif.

Correspondence to Heather J. Fullerton, MD, MAS, University of California, San Francisco, Department of Neurology, Box 0114, San Francisco, CA 94143-0114. E-mail fullertonh{at}neuropeds.ucsf.edu

Background and Purpose— Although hemorrhagic strokes (HS) account for half of all strokes in children, rates and predictors of recurrent HS have not been studied.

Methods— We collected data on all documented cases of HS (intracerebral hemorrhage, subarachnoid hemorrhage, and intraventricular hemorrhage, except neonatal intraventricular hemorrhage), among 2.3 million children (<20 years) enrolled in a Northern Californian health maintenance organization from January 1993 to December 2004. Using Kaplan-Meier survival analyses censoring at death or loss to follow-up, we determined rates of recurrent HS. Log rank tests were used for bivariate comparisons.

Results— Among 116 children with atraumatic incident HS followed for a mean of 4.2 years, 11 had a recurrent HS at a median of 3.1 months (range 7 days to 5.7 years), yielding an overall 5-year cumulative recurrence rate (CRR) of 10% (95% CI, 58% to 18%). Sixty-four percent of recurrences were within the first 6 months. Whereas children with idiopathic HS (n=29) had no recurrences, children with structural lesions (vascular malformations or tumors) had a 5-year cumulative recurrence rate of 13% (95% CI, 7% to 25%; 9 recurrences among 71 children; P<0.05 compared with idiopathic). Children with medical etiologies (eg, thrombocytopenia, hypertension) had a 5-year cumulative recurrence rate of 13% (95% CI, 3% to 41%; 2 recurrences among 16 children), but the recurrences were within the first week.

Conclusions— Overall, 1 in 10 children with HS experienced a recurrence within 5 years, despite available therapies. Whereas idiopathic HS rarely recurred, and HS due to medical etiologies tended to recur acutely, children with structural lesions had a high and prolonged risk for recurrence.

Key Words: child • hemorrhagic • recurrence • stroke

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