Abstract DP371: Neurovascular anomalies are a frequent cause of spontaneous childhood hemorrhagic stroke: Results of the International Pediatric Stroke Study

Approximately half of strokes in children are hemorrhagic, but basic epidemiologic factors remain understudied. We sought to create an international, multicenter registry of children who sustained an acute hemorrhagic stroke. Methods: Longitudinal cohort study within the existing infrastructure of the International Pediatric Stroke Study consortium. Inclusion: children < 18 years with spontaneous hemorrhagic stroke (intraparenchymal, intraventricular, subarachnoid or subpial hemorrhage). Exclusion: hemorrhage due to trauma; hemorrhagic transformation of a primary ischemic infarction; isolated subdural or epidural hemorrhage. Clinical data were collected at local sites after ethics approval. Outcomes were measured using the Pediatric Stroke Outcome Measure (PSOM) a 10-point scale where 0-1 indicates good outcome (defined as no/minimal functional deficit). Results: Investigators at 24 sites enrolled 406 patients, which included both neonatal (n=75,18.5%) and childhood strokes (n=331, 81.5%). Demographics and clinical characteristics are shown in Table 1. A neurovascular anomaly was identified as a source of hemorrhage in 9 neonates (12%) and 241 children (72.8%). Death due to stroke occurred in 20 (4.9%), and an additional 7 (1.7%) died from other causes prior to hospital discharge. Table 2 provides survivor outcomes, stratified by age group at the time of stroke. PSOM was available for 60 (86%) of neonatal hemorrhagic stroke survivors at a median of 1.8 months. Among these, 83% had a good outcome (as a continuous measure: median 0, interquartile range 0, 5). After childhood hemorrhagic stroke, a PSOM was available in 237 (76%) at a median of 8.4 months post-stroke, and 73% were categorized as a good outcome (as a continuous measure: median 0.5, interquartile range 0, 1.5). Conclusions: Neurovascular anomalies such as brain arteriovenous malformation, arteriovenous fistula or aneurysm were frequently identified in children with hemorrhagic stroke. These findings maybe an underestimate due to lack of vascular imaging. Chronic hypertension is an infrequent risk factor. Most of the survivors with available follow-up attained good outcomes. Vascular imaging is critical for children with hemorrhagic stroke to identify potentially treatable anomalies and prevent stroke recurrence.