Associated factors, determination of etiology and neurological outcomes in neonatal and childhood haemorrhagic strokes

Pediatric haemorrhagic stroke is a rare condition compared to the adult age group, yet it results in mortality or causes patients to live with neurological deficits for many years. We retrospectively reviewed the patients with haemorrhagic stroke during neonatal period and childhood diagnosed and followed-up at Hacettepe University İhsan Doğramacı Children's Hospital between 2000 and 2023. We studied demographic characteristics, neurological examination findings, risk factors, neuroradiological findings and outcome aiming to reveal clinical and radiological features that could predict prognosis and neurological outcome. In our study, 61 childhood and five neonatal cases were included. The median age at diagnosis in childhood was seven years. Patients most commonly presented with focal neurological findings (55.7%) and altered mental status (34.4%). Haematological (36.1%) and vascular risk factors (29.5%) were the most common etiological factors. Haemorrhage was frequently intraparenchymal, mostly involving the frontal lobe (32.7%). Stroke-related mortality was observed in 30.5% of patients. Cerebral oedema treatment (72.4%) was the most common treatment. Presence of a known disease, male gender, GCS <8, presence of subarachnoid haemorrhage, and increased haemorrhage size were associated with poor outcome and mortality. The median age at diagnosis in the neonatal group was 17 days. Hematological risk factors were detected in three of these patients. One patient resulted in neurological deficit, one patient developed epilepsy, and one patient died. Our study revealed that patients with pediatric hemorrhagic stroke had a heterogeneous etiological profile, vascular and hematological etiology as the most common causes. Although haemorrhagic stroke is not common in the pediatric age group, it is a neurological disease with serious consequences. Timely diagnosis of stroke is of critical importance; clarification of the etiology after diagnosis will be decisive in guiding the treatment and predicting the course of the disease and recurrences. Key words: Pediatric stroke, perinatal stroke, haemorrhagic stroke, cerebrovascular disease, vascular malformation