Hemorragia cerebral no traumatica en la infancia: Etiologia, manifestaciones clinicas y manejo

Objective: Non-traumatic intracraneal hemorrhage is a rare occurrence in children, with the most frequent etiology being vascular malformation. Our aim was to review the etiology and management of spontaneous cerebral hemorrhage in children. Patients and methods: We have reviewed the patients admitted to our intensive care unit (ICU) with spontaneous intracraneal hemorrhage from 1980 to 1998. The etiology, symptoms and their clinical management were analyzed. Results: Forty patients with non-traumatic intracraneal hemorrhage were admitted during this time period. The mean age was 6.8 years and the male/female ratio was 2.4/1. This condition presented with a sudden onset in 83%. The most common form of presentation was headache, vomiting and altered consciousness. The most frequent etiology was vascular malformation (32.2%). Initial management was symptomatic and addressed the prevention or treatment of intracraneal hypertension and seizures. Mortality was 38% and there were sequelae in 35%. Conclusions: Management of critical non-traumatic intracraneal hemorrhage consists in preventing or treating cerebral hypertension. The monitoring of intracraneal pressure, jugular oxygen saturation and transcranial Doppler allows an indirect measurement of cerebral blood flow. Prompt excision of the hematoma improves the outcome. In vascular malformations, endovascular embolization or radiosurgery are possible.