Bleed size key to prognosis after childhood hemorrhagic stroke

By Eleanor McDermid, Senior medwireNews Reporter

Hemorrhage volume is an important predictor of long-term outcomes in children who survive hemorrhagic stroke, a study shows.

But in contrast with findings in adults, initial Glasgow Coma Scale score, the location of the bleed, and ventricular involvement had no detectable influence on long-term outcomes, report the researchers.

Warren Lo (Ohio State University and Nationwide Children's Hospital, Columbus, USA) and colleagues note that their study is one of just two that followed up children several years after hemorrhagic stroke.

"As the long-term outcomes of hemorrhagic stroke become better characterized, physicians will be better able to recognize the range of sequelae that occur and identify the potential for long-term problems and thus be better able to help their patients," they write in the Archives of Neurology.

The team studied 59 children, who had hemorrhagic stroke at a median of 10 years old (range 0.1 to 18 years). Twenty children did not participate in the follow-up study, and 20 died of their stroke or a related illness.

Lo et al say that, together with previous findings, "the results indicate that the estimated mortality rate from childhood hemorrhagic stroke is lower than the 39% to 53% 1-year mortality seen in adults."

They add: "Furthermore, childhood survivors appear to have higher levels of functioning compared with adult survivors."

The 19 children who were followed up were a median of 17 years old. Their median Recovery and Recurrence Questionnaire (RRQ) at this time was 1, representing mild to moderate impairment, and their median King's Outcome Scale for Childhood Head Injury (KOSCHI) score was 5A, indicating minimal impairment of daily functioning.

But although the children's self-rated quality-of-life (QoL) scores were in line with normal values for emotional and social function, they were significantly reduced for physical health and school function.

The size of the initial brain hemorrhage predicted outcomes, with larger ratios of hemorrhage to brain volume significantly associated with poorer scores for all measures. The researchers found a threshold effect, with a ratio of 4% the point at which hemorrhage size began to significantly affect QoL, RRQ, and KOSCHI scores later in life.

The only other significant outcome predictor was the underlying cause of the stroke; children with hemorrhage arising from an intracranial vascular anomaly had higher QoL scores than those who had malignancies or congenital heart disease.

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