M Alaa Fakhr, M.D.

Professor And Chairman

Neurosurgery Department,

Director of Vascular Program,

Ain Shams University,

Cairo, Egypt.

Zaafaran PalaceAin Shams University Main Campus

Ain Shams University: Main Campus

Childhood stroke is more common than brain tumors and is among the top 10 causes of death in pediatric age group with the highest mortality during the first year of life .

The international incidence of childhood stroke is 1.3 to 13 per 100,000 in children, and up to 63 per 100,000 live births in neonates .

In comparison to adult stroke, there is limited understanding of the etiology, treatment and predictors of outcome of the pediatric type.

This study was conducted on 80 consecutive pediatric patients suffering from cerebrovascular diseases that were managed in Ain Shams University hospitals along a period of 2 years

Ain Shams University Hospital

The patients were followed up for another 2 years at the end of which the outcome of treatment was evaluated as follows:

Good: patients having no significant disability and able to carry out usual activities and younger patients should have normal milestones

Fair: patients having significant disability and younger age groups may have some delay of milestones.

Bad: patients with severe disability requiring constant nursing care or cerebral palsy for younger children

Death.

Age:

Neonates (0-30 days): 12 pts (15%)

Infants (2-24 months): 23 pts (28.75%)

Children(up to 18 years): 45 pts (56.25%)

Sex:

Males: 43

Females: 37

M:F 1.1:1

42% of neonates were premature.

22.6% of all patients had cardiorespiratory problems.

17.5% of all patients had abnormalbleeding profile.

Clinical Picture

Altered conscious level 61%

Seizures 47%

Neurological Deficit 39%

Poor Feeding 35%

Neuro-Radiology

CT Scan

MRI and MRA

3 DCT Angiography

Cerebral Angiography

DiagnosisDIAGNOSIS NUMBER %

AVMs 12 15

Aneurysms 10 12.5

AV Fistulas 6 7.5

Vein of Galen Aneurysms 7 8.75

Cavernomas 3 3.75

Bleeding tendency (SDH-EDH-ICH) 8 10

Germinal Matrix Hemorrhage of neonates

4 5

Hemorrhage in a tumor 3 3.75

Infarctions 9 11.25

ICH of unknown etiology 18 22.5

Diagnosis AVMs: 12

9 with ICH – 3 with seizures

Aneurysms: 10

9 with SAH – 1 with ICH

AV Fistulas: 6

3 Carotico cavernous - 3 Dural

Diagnosis

Bleeding tendency : 8

4 with SDH

3 with ICH

1 with EDH

ManagementFactors affecting decision making:

Pathology type

Age

General condition of the patient

Parents’ approval

Financial status

AVMs (12)Radiosurgery 5

Endovascular Therapy 4

Surgical Excision 2

Antiepileptic Treatment 1

AVMs (12)Radiosurgery 5

Endovascular Therapy 4

Surgical Excision 2

Antiepileptic Treatment 1

Aneurysms (10) Clipping 5

Coiling 3

Medical Treatment 2

1 Mycotic aneurysm

1 Aortic coarcitation + malignant

hypertension + multiple aneurysms

Vein of Galen Aneurysm(7)Endovascular Therapy 4

V P Shunt 2

Medical Treatment 1

Cavernomas (3)Surgical Excision 1

Radiosurgery 1

Medical Treatment 1

AV Fistulas (6)

Endovascular Therapy 4

Medical Treatment 2

A 9 year old child presented with Left Traumatic CCF following penetrating trauma

Immediate post procedural angiography

Management (cont.) Patients with bleeding tendency (n:8):

Conservative TTT

GMH of neonates (n: 4)V P Shunt 2Conservative TTT 2

Hemorrhage in tumors (n: 3)Surgical excision

ICH of unknown etiology (n: 18)Conservative TTT 7Surgical evacuation 5V P Shunt 5ETV 1

Total Interventional Procedures 42

Total Conservative Treatment 38

OutcomeInterventional (%) Conservative (%)

Good 15 35.7% 7 18.4%

Fair 14 33.3% 9 23.7%

Bad 7 16.7% 6 15.8%

Death 6 14.3% 16 42%

42 100% 38 100%

CONCLUSION

Interventional modalities carried better prognostic values than conservative ones

Thank You

One week post procedural angiography