Intracranial aneurysms and subarachnoid hemorrhage in children and adolescents

• Published in: Child's nervous system 1986-01, Vol.2 (4), p.185-190
• Main Authors: Pasqualin, A, Mazza, C, Cavazzani, P, Scienza, R, DaPian, R
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Cerebral Angiography; Child; Humans; Intracranial Aneurysm - complications; Intracranial Aneurysm - diagnostic imaging; Rupture, Spontaneous; Subarachnoid Hemorrhage - etiology; Tomography, X-Ray Computed
• ISSN: 0256-7040; 1433-0350
• DOI: 10.1007/bf00706808

Thirty-eight cases of symptomatic cerebral aneurysms or spontaneous subarachnoid hemorrhage in children and adolescents were observed from 1965 to 1984; 33 cases were treated from 1970 to date. This group represents 2.6% of the total number of patients with subarachnoid hemorrhage treated at our institute in the same period. The cause of subarachnoid hemorrhage was unknown in 7 cases; an intracranial aneurysm had ruptured in 29 cases, and was unruptured but symptomatic in 2 remaining cases. Three aneurysms were mycotic. The most frequent aneurysmal locations were the internal carotid bifurcation and the anterior communicating artery; peripheral branches of the middle cerebral artery were also a relatively common location. Four patients were 3 years of age or younger: each presented peculiar clinical features, and 3 of the 4 had middle cerebral artery aneurysms. The remaining 34 patients were all above 9 years of age. Two groups were identified: (a) in 14 patients between 10 and 15 years of age, the aneurysm was most commonly at the internal carotid bifurcation (37%), and an intracerebral hematoma was observed in 50% of these cases; (b) in 20 patients between 16 and 20 years of age, the most common aneurysmal location was the anterior communicating artery (35%), and intracerebral hematomas were rare (10% of cases). Among patients with aneurysms, 19 underwent surgical exclusion by clip, with 10% morbidity and 5% mortality; 5 patients in moribund conditions were not operated on; 5 patients were conservatively treated; in 2 patients the aneurysm had disappeared at a second angiography.