P292 Strokes in children and adolescents. Α case-report of a 13-year-old female

• Published in: Archives of disease in childhood 2017-06, Vol.102 (Suppl 2), p.A146-A147
• Main Authors: Bampalitsa, Sofia-Dimitra, Velali, Kyriaki N, Gianniki, Maria G, Anastasiou-Katsiardani, Anastasia
• Format: Article
• Language: English
• Subjects: Adolescents; Aging (Individuals); Blood; Blood levels; Children; Computed tomography; Diabetes; Diabetes mellitus (insulin dependent); Differential diagnosis; Dysarthria; Edema; Emergency medical care; Headache; Hemorrhage; Hyperlipidemia; Hypoglycemia; Leukocytes; Mannitol; Morbidity; Narcotics; Neonates; Older people; Patients; Pediatrics; Personnel; Seizures; Stroke; Teenagers; Vomiting; Young adults
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2017-313273.380

BackgroundAlthough more common in older adults, stroke also occurs in neonates, infants, children, and young adults, resulting in significant morbidity and mortalityAimThe description and differential diagnosis of a 13-year-old female adolescent with haemorrhagic stroke and a personal history of diabetes mellitus type 1, hyperlipidemia under ezetimibe. The general paediatrician should be informed that stokes occur in children, although in a lower percentage than adults.Result13-year-old adolescent was brought to the emergency department because of hypoglycemia ( GLC: 50mcg/dl at home), headache, dysarthria and vomiting ( 3 times) the last 3 hours. Personal history: diabetes mellitus type 1(insulin-dependent) and hyperlipidemia under treatment with ezetimibe. She was admitted to the department of Paediatrics, BP: 115/75 mmHg, blood tests showed high leucocyte levels (18.000) with polymorphonuclear leucocyte type ( 80%), because of vomiting, CRP and ESR were not elevated. Glucose blood levels were restored with no signs of improvement. Because of a headache, she had a paranasal x-ray. As the time was going by, the patient became intoxicated with worsening dysarthria. Because of lack of executive personnel in our hospital, she was transferred to the tertiary hospital with GCS: 13/15. A computed tomography was conducted that showed a wide haemorrhage on the right temporoparietal lobe with 3,5 cm diameter, surrounded by oedema that shifted the midline structure to the left for 4,5 cm. The spinal basal system and Willis circle were intact. She was treated with mannitol, anti-seizure drugs and painkillers. One week later, an MRI was conducted that showed the haemorrhage with the same size of surrounding oedema. The antiedematous drugs were sustained for several days, the clinical appearance of the teenager was improved.ConclusionThis case report signifies a) the incidence of strokes in children, although it is in low percentage, so that general paediatricians are alerted about these cases, b) the lack of executive personnel and technical materials in greek hospitals due to the financial crisis of the recent years and the consequences of this situation on patient outcome