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(Stroke. 2009;40:400.)
© 2009 American Heart Association, Inc.

Original Contributions

The Importance of Cerebral Aneurysms in Childhood Hemorrhagic Stroke

A Population-Based Study

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

From the Department of Neurology (L.C.J.), Johns Hopkins University School of Medicine, Baltimore, Md; the Departments of Neurology (Y.W.W., S.C.J., H.J.F.), Pediatrics (Y.W.W., H.J.F.), and Epidemiology (S.C.J.), University of California, San Francisco, Calif; and the Division of Research (S.S.), Kaiser Permanente Medical Care Program, 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— Prior population-based studies of pediatric hemorrhagic stroke (HS) had too few incident cases to assess predictors of cerebral aneurysms, a HS etiology that requires urgent intervention.

Methods— We performed a retrospective cohort study of HS (intracerebral, subarachnoid [SAH], and intraventricular hemorrhage) using the population of all children <20 years of age enrolled in a large Northern Californian healthcare plan (January 1993 to December 2003). Cases were identified through electronic searches and confirmed through independent chart review by 2 neurologists with adjudication by a third; traumatic hemorrhages were excluded. Logistic regression was used to examine potential predictors of underlying aneurysm.

Results— Within a cohort of 2.3 million children followed for a mean of 3.5 years, we identified 116 cases of spontaneous HS (overall incidence, 1.4 per 100000 person-years). Cerebral aneurysms were identified in 15 (13%) of HS cases. Among 21 children with pure SAH, 57% were found to have an underlying aneurysm compared with only 2% of 58 children with pure intracerebral hemorrhage and 5% of 37 children with a mixed pattern of hemorrhage (intracerebral hemorrhage and SAH). Independent predictors of an underlying aneurysm included pure SAH (OR, 76; 95% CI, 9 to 657; P<0.001) and late adolescent age (15 to 19 years versus younger age groups; OR, 6.4; 95% CI, 1.0 to 40; P=0.047).

Conclusions— Cerebral aneurysms cause the majority of spontaneous SAH in children and account for more than 10% of childhood HS overall. Children, and particularly teenagers, presenting with spontaneous SAH should be promptly evaluated with cerebrovascular imaging.

Key Words: aneurysm • child • hemorrhagic • stroke