A CASE OF CHILDHOOD STROKE

Abstract

Introduction

Haemorrhagic stroke in children is rare with incidence of approximately 1 to 1.7 in 100 000 per annum. Early recognition and timely management are crucial in preserving cerebral function, promoting healing and recovery.

Case report

An 8-year old girl was brought into our Emergency Department (ED) for altered mental status preceded by sudden headache, with projectile vomiting. She was previously well and no recent trauma. Patient was an ex-premature at 30-week as her mother had preeclampsia. Upon reassessment, her Glasgow Coma Scale (GCS) was E₂V₂M_5, pupils were reactive to light and her vitals showed no panoply of Cushing reflex. Elective intubation was performed for cerebral protection. Computerized Tomography (CT) brain demonstrated cerebellar haemorrhage with acute hydrocephalus. Decompression craniotomy and frontal extra-ventricular drain were planned and proceeded. She made a conspicuous recovery with no neurological complications. Subsequent CT Angiography and Magnetic Resonance Angiography brain were done, but there were no abnormal vasculatures. Unfortunately, there was no further haematological testing done in this child.

Discussion

Most common cause of childhood haemorrhagic stroke is vascular malformation followed by haematological disorder. Digital subtraction angiography remains the gold standard imaging to diagnose Arteriovenous Malformation (AVM). Cryptic AVM which is also known as “hidden” or small AVM that buries at brain parenchyma, it is sometimes not evident through angiography. Its diagnosis is infrequently made during surgery or autopsy. However, majority of the cases remain idiopathic. Outcome is generally favourable in children over 2 year-old comparing to those below 2 year-old, who experience more complications due to impaired cerebral autoregulation.

Conclusion

A high index of suspicion, early recognition and timely management are paramount’s in managing haemorrhagic stroke in children. Intracranial haemorrhage remains a debilitating disease considerably, especially when there is no identifiable underlying cause. We are glad our patient made a remarkable recovery.