Ruptured vascular malformations are the most common cause of intracerebral haemorrhage in children, causing significant morbidity and mortality.
To describe the therapeutic approach and neurological outcome in patients admitted to a paediatric intensive care unit (PICU) with arteriovenous malformations (AVMs) and cerebral aneurysms (CAs).
Retrospective chart review of patients admitted to PICU with AVMs and CAs between January 2008 and December 2018. Neurologic outcome was assessed using King’s Outcome Scale for Childhood Head Injury (KOSCHI), considering good recovery KOSCHI 4-5; vegetative/ severe disability KOSCHI 2-3.
28 cases of AVMs (64%) and 16 CAs (36%) were included: mean age 8.9 years (+/-5.1). Brain CT scan showed subarachnoid hemorrhage in 63% of CAs and parenchymatous haemorrhage in 64% of AVMs. All patients had neurocritical care, fifty-percent of patients underwent neurosurgery and 23% neuroradiological intervention. Seizures were more common in the AVM group (29 vs 6%), unlike vasospasm (11 vs 25%). Rebleeding rate was similar between groups (18 vs 19%), but occurred earlier and with higher mortality in CAs (2/3 within 48h of admission, both died) than AVMs (5/5 after the first week, one died). Another patient died, from ruptured CA (brain death on admission). On transfer from PICU, incidence of neurologic sequelae was similar (57% in AVMs vs 50% in CAs group). At present time: 75% of AVMs vs 69% of ACs show good recovery; 39% of AVMs vs 6,25% of CAs have severe disability.
Early rebleeding had a dismal outcome in our series, justifying a prompt intervention in cases of CAs.