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Stadulni ARP, Sleifer P, Berticelli AZ, Riesgo R, Rocha-Muniz CN, Schochat E. Stroke in children and adolescents: Analysis of electrophysiological and behavioral assessment findings of auditory processing. Clinics (Sao Paulo) 2023; 78:100286. [PMID: 37812955 PMCID: PMC10569949 DOI: 10.1016/j.clinsp.2023.100286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 08/25/2023] [Accepted: 09/06/2023] [Indexed: 10/11/2023] Open
Abstract
PURPOSE This study aimed to analyze the auditory processing behavior of children and adolescents diagnosed with stroke and compare it with that of typically developing individuals. METHODS This was an analytical cross-sectional study involving 48 participants aged between 7 and 17 years with adequate schooling for age and grade, allocated equally to two groups: Stroke (SG) and Control Groups (CG). For the SG, cases identified between 2003 and 2018 were considered. In the CG, school-aged participants with typical development were randomized. After screening for differential audiological assessment and confirmation of auditory pathway integrity at the brainstem level, binaural analyses of the auditory processing behavior were conducted using the Dichotic Digit Test (DDT), Frequency Pattern Test (FPT), and electrophysiological assessment (P300). The Shapiro-Wilk test for normality was conducted, followed by the T and Mann-Whitney tests, with a 95 % confidence level and significance offset at p < 0.05, using the SPSS software (IBM®, v. 22.) RESULTS: The CG performed better in terms of auditory processing. These differences were significant (p < 0.0001) for the binaural integration of DDT, FPT humming and Labeling, and P300 latency. The P300 results were similar; however, with a greater amplitude in the SG. CONCLUSION This study showed that children and adolescents with stroke performed worse in electrophysiological and behavioral tests of auditory processing assessed using the auditory evoked potentials. These data reinforce the hypothesis that stroke-related lesions compromise the neural mechanisms underlying auditory processing.
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Affiliation(s)
- Andréia Rodrigues Parnoff Stadulni
- Department of Physiotherapy, Speech Therapy and Occupational Therapy, Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP, Brazil.
| | - Pricila Sleifer
- Department of Health and Human Communication, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Amanda Zanatta Berticelli
- Graduate Program in Child and Adolescent Health, Faculdade de Medicina da Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Rudimar Riesgo
- Graduate Program in Child and Adolescent Health, Faculdade de Medicina da Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Hospital de Clínicas (HCPA), Porto Alegre, RS, Brazil
| | - Carolina Nunes Rocha-Muniz
- Department of Physiotherapy, Speech Therapy and Occupational Therapy, Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Eliane Schochat
- Department of Physiotherapy, Speech Therapy and Occupational Therapy, Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP, Brazil
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Pangprasertkul S, Borisoot W, Buawangpong N, Sirikul W, Wiwattanadittakul N, Katanyuwong K, Sanguansermsri C. Comparison of Arterial Ischemic and Hemorrhagic Pediatric Stroke in Etiology, Risk Factors, Clinical Manifestations, and Prognosis. Pediatr Emerg Care 2022; 38:e1569-e1573. [PMID: 35113509 DOI: 10.1097/pec.0000000000002614] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Stroke is relatively rare in children but has a significant impact on long-term morbidity and mortality. There are limited data regarding the etiology, clinical manifestation, and prognosis of arterial ischemic stroke (AIS) and hemorrhagic stroke (HS) in children. OBJECTIVE The aim of this study is to identify and compare etiology, risk factors, clinical manifestations, and prognostic outcomes between arterial ischemic and hemorrhagic pediatric stroke. METHODS We retrospectively reviewed all hospital medical records and pediatric neurology database of 83 children who were first diagnosed with AIS and HS at the Pediatric Department, Chiang Mai University Hospital, Chiang Mai, Thailand between January 1, 2009, and December 31, 2018. All children were from 1 month to 18 years old. RESULTS Fifty-one AIS (56%) and 32 (35.2%) HS were identified. The median age of onset was 6.9 years for AIS and 5.3 years for HS. Moyamoya disease/syndrome was the most common cause in AIS (21.6%). Rupture of cerebral arteriovenous malformation was the most common cause in HS (21.9%). More than one-third (39%) of children had multiple risk factors associated with stroke. Iron deficiency anemia was commonly found in children with AIS (39.2%). The majority of clinical presentations were hemiparesis (80.4%) for AIS and alteration of consciousness (68.8%) for HS. The median time to diagnosis exceeded 6 hours in both AIS and HS. The overall mortality rate of acute stroke was 5.1 per 100 person-years (95% confidence interval [CI], 2.9-9). The mortality rate was higher in HS compared with that in AIS with statistical significance (16.6; 95% CI, 8.9-30.8 vs 1.1%; 95% CI, 0.3-4.6 per 100 person-years). Thirty children (36.1%) developed epilepsy during the follow-up (median duration, 26 months). Recurrent stroke occurred in 1 child with AIS and 1 child with HS. CONCLUSIONS Moyamoya disease/syndrome and arteriovenous malformation rapture are the most common cause of AIS and HS, respectively. Iron deficiency anemia was commonly found in childhood AIS. The time to diagnosis in both AIS and HS was delayed. The mortality rate in HS was higher than in AIS. Neurological deficits are seen in 70% of childhood AIS during the follow-up. One-third of the children in our study developed epilepsy, which generally responds to a single antiseizure medication. The recurrence rate of childhood stroke was low compared with adult stroke.
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Affiliation(s)
| | | | | | | | - Natrujee Wiwattanadittakul
- Neurology Division, Department of Pediatrics, Faculty of Medicine, Chiang Mai University Hospital, Chiang Mai, Thailand
| | - Kamornwan Katanyuwong
- Neurology Division, Department of Pediatrics, Faculty of Medicine, Chiang Mai University Hospital, Chiang Mai, Thailand
| | - Chinnuwat Sanguansermsri
- Neurology Division, Department of Pediatrics, Faculty of Medicine, Chiang Mai University Hospital, Chiang Mai, Thailand
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Ciochon UM, Bindslev JBB, Hoei-Hansen CE, Truelsen TC, Larsen VA, Nielsen MB, Hansen AE. Causes and Risk Factors of Pediatric Spontaneous Intracranial Hemorrhage—A Systematic Review. Diagnostics (Basel) 2022; 12:diagnostics12061459. [PMID: 35741269 PMCID: PMC9221737 DOI: 10.3390/diagnostics12061459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 01/10/2023] Open
Abstract
Previous studies suggest that the most common cause of spontaneous intracerebral hemorrhage in children and adolescents is arteriovenous malformations (AVMs). However, an update containing recently published data on pediatric spontaneous intracranial hemorrhages is lacking. The aim of this study is to systematically analyze the published data on the etiologies and risk factors of pediatric spontaneous intracranial hemorrhage. This systematic review was performed in compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A search in PubMed, Embase, Scopus, Web of Science and Cochrane Library was conducted aiming for articles published in year 2000 and later, containing data on etiology and risk factors of spontaneous intracranial hemorrhages in unselected cohorts of patients aged between 1 month and 18 years. As a result, forty studies were eligible for data extraction and final analysis. These included 7931 children and adolescents with 4009 reported etiologies and risk factors. A marked variety of reported etiologies and risk factors among studies was observed. Vascular etiologies were the most frequently reported cause of pediatric spontaneous intracranial hemorrhages (n = 1727, 43.08% of all identified etiologies or risk factors), with AVMs being the most common vascular cause (n = 1226, 70.99% of all vascular causes). Hematological and systemic causes, brain tumors, intracranial infections and cardiac causes were less commonly encountered risk factors and etiologies.
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Affiliation(s)
- Urszula Maria Ciochon
- Department of Diagnostic Radiology, Copenhagen University Hospital—Rigshospitalet, 2200 Copenhagen, Denmark
- Correspondence:
| | - Julie Bolette Brix Bindslev
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital—Rigshospitalet, 2200 Copenhagen, Denmark
| | - Christina Engel Hoei-Hansen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital—Rigshospitalet, 2200 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Thomas Clement Truelsen
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
- Department of Neurology, Copenhagen University Hospital—Rigshospitalet, 2200 Copenhagen, Denmark
| | - Vibeke Andrée Larsen
- Department of Diagnostic Radiology, Copenhagen University Hospital—Rigshospitalet, 2200 Copenhagen, Denmark
| | - Michael Bachmann Nielsen
- Department of Diagnostic Radiology, Copenhagen University Hospital—Rigshospitalet, 2200 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Adam Espe Hansen
- Department of Diagnostic Radiology, Copenhagen University Hospital—Rigshospitalet, 2200 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
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Ciechanowska M, Stachurski J. Differentiating stroke, transient ischemic attack, or hemiplegic migraine in a teenager: a case report. MEDICAL SCIENCE PULSE 2021. [DOI: 10.5604/01.3001.0015.0631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The symptoms of stroke in the pediatric population are less evaluated than in adults. Although
certain indicators are characteristic of stroke – acute drooping of the mouth corners, hemiparesis, and headache
– they are not pathognomonic. Other diseases may manifest with similar symptoms, such as the first
episode of hemiplegic migraine, and should be differentiated from stroke at an emergency department.
Aim of the study: We present the differential diagnosis between stroke, transient ischemic attack, and first
episode of hemiplegic migraine in a teenager with alarming focal symptoms.
Case report: We present a case of 15-year-old patient with acute headache, drooping of the right mouth
corners, and hemiparesis of the right upper and lower limb. He was brought by ambulance to the emergency
department under suspicion of a stroke. A series of diagnostic tests performed at the Emergency Department
did not reveal any vascular incident. Further diagnosis was performed at the Neurology Department. The
patient was discharged from the hospital with a suspicion of first attack of hemiplegic migraine or transient
ischemic attack.
Conclusions: Differentiating stroke from other conditions in young patients is a significant challenge. The
stroke diagnostic process in children requires further research to support accurate diagnosis and, if necessary,
treatment as rapidly as possible.
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Affiliation(s)
- Monika Ciechanowska
- Research Association of Pediatric Emergency Medicine, Medical University of Warsaw, Poland
| | - Jan Stachurski
- Department of Pediatric Emergency Medicine, Faculty of Health Sciences, Medical University of Warsaw, Poland
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Van de Voorde P, Turner NM, Djakow J, de Lucas N, Martinez-Mejias A, Biarent D, Bingham R, Brissaud O, Hoffmann F, Johannesdottir GB, Lauritsen T, Maconochie I. [Paediatric Life Support]. Notf Rett Med 2021; 24:650-719. [PMID: 34093080 PMCID: PMC8170638 DOI: 10.1007/s10049-021-00887-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 12/11/2022]
Abstract
The European Resuscitation Council (ERC) Paediatric Life Support (PLS) guidelines are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations of the International Liaison Committee on Resuscitation (ILCOR). This section provides guidelines on the management of critically ill or injured infants, children and adolescents before, during and after respiratory/cardiac arrest.
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Affiliation(s)
- Patrick Van de Voorde
- Department of Emergency Medicine, Faculty of Medicine UG, Ghent University Hospital, Gent, Belgien
- Federal Department of Health, EMS Dispatch Center, East & West Flanders, Brüssel, Belgien
| | - Nigel M. Turner
- Paediatric Cardiac Anesthesiology, Wilhelmina Children’s Hospital, University Medical Center, Utrecht, Niederlande
| | - Jana Djakow
- Paediatric Intensive Care Unit, NH Hospital, Hořovice, Tschechien
- Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno, Medical Faculty of Masaryk University, Brno, Tschechien
| | | | - Abel Martinez-Mejias
- Department of Paediatrics and Emergency Medicine, Hospital de Terassa, Consorci Sanitari de Terrassa, Barcelona, Spanien
| | - Dominique Biarent
- Paediatric Intensive Care & Emergency Department, Hôpital Universitaire des Enfants, Université Libre de Bruxelles, Brüssel, Belgien
| | - Robert Bingham
- Hon. Consultant Paediatric Anaesthetist, Great Ormond Street Hospital for Children, London, Großbritannien
| | - Olivier Brissaud
- Réanimation et Surveillance Continue Pédiatriques et Néonatales, CHU Pellegrin – Hôpital des Enfants de Bordeaux, Université de Bordeaux, Bordeaux, Frankreich
| | - Florian Hoffmann
- Pädiatrische Intensiv- und Notfallmedizin, Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Ludwig-Maximilians-Universität, München, Deutschland
| | | | - Torsten Lauritsen
- Paediatric Anaesthesia, The Juliane Marie Centre, University Hospital of Copenhagen, Kopenhagen, Dänemark
| | - Ian Maconochie
- Paediatric Emergency Medicine, Faculty of Medicine Imperial College, Imperial College Healthcare Trust NHS, London, Großbritannien
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Van de Voorde P, Turner NM, Djakow J, de Lucas N, Martinez-Mejias A, Biarent D, Bingham R, Brissaud O, Hoffmann F, Johannesdottir GB, Lauritsen T, Maconochie I. European Resuscitation Council Guidelines 2021: Paediatric Life Support. Resuscitation 2021; 161:327-387. [PMID: 33773830 DOI: 10.1016/j.resuscitation.2021.02.015] [Citation(s) in RCA: 151] [Impact Index Per Article: 50.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
These European Resuscitation Council Paediatric Life Support (PLS) guidelines, are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidelines on the management of critically ill infants and children, before, during and after cardiac arrest.
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Affiliation(s)
- Patrick Van de Voorde
- Department of Emergency Medicine Ghent University Hospital, Faculty of Medicine UG, Ghent, Belgium; EMS Dispatch Center, East & West Flanders, Federal Department of Health, Belgium.
| | - Nigel M Turner
- Paediatric Cardiac Anesthesiology, Wilhelmina Children's Hospital, University Medical Center, Utrecht, Netherlands
| | - Jana Djakow
- Paediatric Intensive Care Unit, NH Hospital, Hořovice, Czech Republic; Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno, Medical Faculty of Masaryk University, Brno, Czech Republic
| | | | - Abel Martinez-Mejias
- Department of Paediatrics and Emergency Medicine, Hospital de Terassa, Consorci Sanitari de Terrassa, Barcelona, Spain
| | - Dominique Biarent
- Paediatric Intensive Care & Emergency Department, Hôpital Universitaire des Enfants, Université Libre de Bruxelles, Brussels, Belgium
| | - Robert Bingham
- Hon. Consultant Paediatric Anaesthetist, Great Ormond Street Hospital for Children, London, UK
| | - Olivier Brissaud
- Réanimation et Surveillance Continue Pédiatriques et Néonatales, CHU Pellegrin - Hôpital des Enfants de Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Florian Hoffmann
- Paediatric Intensive Care and Emergency Medicine, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | | | - Torsten Lauritsen
- Paediatric Anaesthesia, The Juliane Marie Centre, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Ian Maconochie
- Paediatric Emergency Medicine, Imperial College Healthcare Trust NHS, Faculty of Medicine Imperial College, London, UK
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Adeeb N, Storey C, Vega AJ, Aslan A, Guthikonda B, Cuellar-Saenz H. Pediatric Middle Cerebral Artery Occlusion with Dissection Following a Trampoline Trauma. World Neurosurg 2020; 143:428-433. [PMID: 32750515 DOI: 10.1016/j.wneu.2020.07.175] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 07/23/2020] [Accepted: 07/26/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Owing to the rarity of acute ischemic stroke in the pediatric population, evidence supporting the efficacy in children of the various treatments used in adults is scanty. This included mechanical thrombectomy for acute ischemic stroke. CASE DESCRIPTION we present the case of an 11-year-old female with acute left hemiparesis, numbness, and left facial droop occurring after tumbling on a trampoline. Computed tomography angiography revealed an 11-mm nonfilling defect in the right middle cerebral artery. She underwent thrombectomy approximately 8.5 hours after the onset of symptoms, and a Thrombolysis in Cerebral Infarction (TICI) scale score of 2b was achieved. She had an uneventful postoperative recovery. CONCLUSION Pediatric patients likely have more reserve and collateral flow and benefit from a longer therapeutic window following acute ischemic stroke.
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Affiliation(s)
- Nimer Adeeb
- Department of Neurosurgery, Ochsner-Louisiana State University, Shreveport, Louisiana, USA.
| | - Christopher Storey
- Department of Neurosurgery, Ochsner-Louisiana State University, Shreveport, Louisiana, USA
| | - Alexis J Vega
- Department of Neurosurgery, Ochsner-Louisiana State University, Shreveport, Louisiana, USA
| | - Asala Aslan
- Department of Neurosurgery, Ochsner-Louisiana State University, Shreveport, Louisiana, USA
| | - Bharat Guthikonda
- Department of Neurosurgery, Ochsner-Louisiana State University, Shreveport, Louisiana, USA
| | - Hugo Cuellar-Saenz
- Department of Neurosurgery, Ochsner-Louisiana State University, Shreveport, Louisiana, USA
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Meliţ LE, Mărginean CO, Simu I, Bucur G. Acute ischemic stroke in a 7-month-old infant, risk factors, and diagnosis peculiarities: A case report. Medicine (Baltimore) 2019; 98:e17864. [PMID: 31725629 PMCID: PMC6867755 DOI: 10.1097/md.0000000000017864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Ischemic stroke is an extremely rare disorder in children. The timely diagnosis is essential for the outcome of these children, but unfortunately, delays in diagnosis occur frequently. PATIENT CONCERNS We report the case of a 7-month-old infant admitted in our clinic for limited movements of the superior and inferior right limbs whose onset was 27 hours before with repeated clonic movements of the right hand associated with the same manifestations in the right oral commissure lasting approximately 10 seconds. DIAGNOSIS The laboratory tests revealed high D-dimers, and positive IgG anti-cardiolipin and anti-beta2 glycoproteins I antibodies, whereas the genetic profile for thrombophilia revealed heterozygote mutation in MTHFR C677T and A1298C genes. Brain imaging established the diagnosis of left frontal ischemic stroke, frontal ischemic stroke, hypoplasia of internal carotid artery, and agenesia of segment M1 of median cerebral artery and segment A1 of left anterior cerebral artery. INTERVENTION We administered low-molecular-weight heparin, antiplatelet therapy along with vasodilators and depletive treatment, wide-spectrum antibiotics, and anticonvulsant therapy. OUTCOME The neurological deficit was greatly improved, especially in the inferior limb after 6 month from the incident of stroke, and all laboratory parameters were within normal limits including the antibodies mentioned above. CONCLUSION Cerebral vascular malformation, excessive weight, and altered lipid profiles contributed to the development of acute ischemic stroke in our patient.
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Affiliation(s)
| | | | - Iunius Simu
- Department of Radiology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures
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Pozzi M, Galbiati S, Locatelli F, Carnovale C, Gentili M, Radice S, Strazzer S, Clementi E. Severe acquired brain injury aetiologies, early clinical factors, and rehabilitation outcomes: a retrospective study on pediatric patients in rehabilitation. Brain Inj 2019; 33:1522-1528. [PMID: 31446793 DOI: 10.1080/02699052.2019.1658128] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: Studies on pediatric severe acquired brain injury (sABI) outcomes focused mostly on single etiologies, not clarifying the independent role of clinical factors, and scantly explored inter-dependence between variables. We assessed associations of clinical factors at admission with essential outcomes, controlling for inter-dependence and sABI etiology. Methods: We reviewed the clinical records of 280 patients with traumatic and 292 with non-traumatic sABI, discharged from intensive care to pediatric neurological rehabilitation. We analyzed the distribution of clinical factors based on sABI etiology; conducted a factor analysis of variables; built multivariate models evaluating the associations of variables with death, persistent vegetative states, duration of coma, GOS outcome, length of stay. Results: We described the study sample. Factor analysis of inter-dependence between GCS, time before rehabilitation, dysautonomia, device use, produced the indicators "injury severity" and "neurological dysfunction", independent from sABI etiology, age, sex, and admittance GOS. Multivariate analyzes showed that: coma duration, GOS outcome, and length of stay, which may depend on rehabilitation courses, were directly associated with injury severity, neurological dysfunction, and patients' age; death and persistent vegetative states were also associated with etiology. Conclusion: Future studies should analyze larger cohorts and investigate mechanisms linking specific etiologies and patients' age with outcomes.
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Affiliation(s)
- Marco Pozzi
- Acquired Brain Injury Unit, Scientific Institute IRCCS Eugenio Medea , Lecco , Italy
| | - Sara Galbiati
- Acquired Brain Injury Unit, Scientific Institute IRCCS Eugenio Medea , Lecco , Italy
| | - Federica Locatelli
- Acquired Brain Injury Unit, Scientific Institute IRCCS Eugenio Medea , Lecco , Italy
| | - Carla Carnovale
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano , Milan , Italy
| | - Marta Gentili
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano , Milan , Italy
| | - Sonia Radice
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano , Milan , Italy
| | - Sandra Strazzer
- Acquired Brain Injury Unit, Scientific Institute IRCCS Eugenio Medea , Lecco , Italy
| | - Emilio Clementi
- Acquired Brain Injury Unit, Scientific Institute IRCCS Eugenio Medea , Lecco , Italy.,Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano , Milan , Italy
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10
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Frösen J, Joutel A. Smooth muscle cells of intracranial vessels: from development to disease. Cardiovasc Res 2019; 114:501-512. [PMID: 29351598 DOI: 10.1093/cvr/cvy002] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 01/12/2018] [Indexed: 02/02/2023] Open
Abstract
Cerebrovascular diseases that cause ischaemic or haemorrhagic stroke with subsequent loss of life or functional capacity due to damage of the brain tissue are among the leading causes of human suffering and economic burden inflicted by diseases in the developed world. Diseases affecting intracranial vessels are significant contributors to ischaemic and haemorrhagic strokes. Brain arteriovenous malformations, which are a collection of abnormal blood vessels connecting arteries to veins, are the most common cause of intracranial haemorrhage in children and young adults. Saccular intracranial aneurysms, which are pathological saccular dilations mainly occurring at bifurcations of the large intracranial arteries near the circle of Willis, are highly prevalent in the middle-aged population, causing significant anxiety and concern; their rupture, although rare, is a significant cause of intracranial haemorrhage in those past middle age that is associated with a very sinister prognosis. Cerebral small-vessel disease, which comprise all pathological processes affecting vessels <500 microns in diameter, account for the majority of intracerebral haemorrhages and ∼25% of ischaemic strokes and 45% of dementias in the elderly. In this review, we summarize the developmental, structural, and functional features of intracranial vessels. We then describe the role of smooth muscle cells in brain arteriovenous malformations, intracranial aneurysms, and small-vessel diseases, and discuss how the peculiar ontogeny, structure, and function of intracranial vessels are related to the development of these diseases.
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Affiliation(s)
- Juhana Frösen
- Hemorrhagic Brain Pathology Research Group, NeuroCenter, Kuopio University Hospital, Kuopio 70029, Finland.,Department of Neurosurgery, Kuopio University Hospital, Kuopio 70029, Finland
| | - Anne Joutel
- Genetics and Pathogenesis of Cerebrovascular Diseases, INSERM, Université Paris Diderot-Paris 7, 10 av de Verdun, Paris 75010, France.,DHU NeuroVasc, Sorbonne Paris Cité, Paris 75010, France
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11
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Saida K, Kim CA, Ceroni JRM, Bertola DR, Honjo RS, Mitsuhashi S, Takata A, Mizuguchi T, Miyatake S, Miyake N, Matsumoto N. Hemorrhagic stroke and renovascular hypertension with Grange syndrome arising from a novel pathogenic variant in YY1AP1. J Hum Genet 2019; 64:885-890. [PMID: 31270375 DOI: 10.1038/s10038-019-0626-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 04/28/2019] [Accepted: 05/17/2019] [Indexed: 11/09/2022]
Abstract
Pediatric hypertension can cause hypertensive emergencies, including hemorrhagic stroke, contributing to rare but serious childhood morbidity and mortality. Renovascular hypertension (RVH) is one of the major causes of secondary hypertension in children. Grange syndrome (MIM#602531) is a rare disease characterized by multiple stenosis or occlusion of the renal, abdominal, coronary, and cerebral arteries, which can cause phenotypes of RVH and fibromuscular dysplasia (MIM#135580). We report the case of a 7-year-old girl with Grange syndrome who showed RVH and multiple seizure episodes. At 1 year of age, she experienced seizures and sequential hemiparesis caused by a left thalamic hemorrhage without cerebral vascular anomalies. Chronic hypertension was observed, and abdominal computed tomography angiography showed characteristic bilateral renal artery stenosis. Whole-exome sequencing revealed a novel homozygous pathogenic variant in the YY1AP1 gene (NM_001198903.1: c.1169del: p.Lys390Argfs*12). Biallelic YY1AP1 mutations are known to cause Grange syndrome. Unlike previously reported patients, our patient presented with intracerebral hemorrhagic stroke without anomalous brain artery or bone fragility. The phenotype in our patient may help better understand this ultra-rare syndrome. Grange syndrome should be considered in patients presenting with childhood-onset hypertension and/or hemorrhagic stroke for early clinical intervention.
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Affiliation(s)
- Ken Saida
- Department of Human Genetics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Chong Ae Kim
- Genetics Unit, Instituto da Crianca, Faculdade de Medicina, Universidade de Sao Paulo, SP, Brazil
| | | | - Debora Romeo Bertola
- Genetics Unit, Instituto da Crianca, Faculdade de Medicina, Universidade de Sao Paulo, SP, Brazil
| | - Rachel Sayuri Honjo
- Genetics Unit, Instituto da Crianca, Faculdade de Medicina, Universidade de Sao Paulo, SP, Brazil
| | - Satomi Mitsuhashi
- Department of Human Genetics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Atsushi Takata
- Department of Human Genetics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Takeshi Mizuguchi
- Department of Human Genetics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Satoko Miyatake
- Department of Human Genetics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Noriko Miyake
- Department of Human Genetics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan.
| | - Naomichi Matsumoto
- Department of Human Genetics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan.
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Briggs B, James KN, Chowdhury S, Thornburg C, Farnaes L, Dimmock D, Kingsmore SF. Novel Factor XIII variant identified through whole-genome sequencing in a child with intracranial hemorrhage. Cold Spring Harb Mol Case Stud 2018; 4:mcs.a003525. [PMID: 30404926 PMCID: PMC6318776 DOI: 10.1101/mcs.a003525] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 10/23/2018] [Indexed: 12/31/2022] Open
Abstract
Pediatric stroke can be either hemorrhagic or ischemic, with ∼5% of hemorrhagic strokes being caused by genetic coagulopathies. We report an 8 mo old presenting with a hemorrhagic stroke caused by severe Factor XIII deficiency (OMIM # 613225) in whom rapid whole-genome sequencing identified a novel variant in the F13A1 gene c.1352_1353delAT (p.His451ArgfsTer29).
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Affiliation(s)
- Benjamin Briggs
- Rady Children's Institute of Genomic Medicine, University of California, San Diego, California 92123, USA;,Department of Pediatrics, Division of Hematology and Oncology, University of California, San Diego, California 92123, USA
| | - Kiely N. James
- Rady Children's Institute of Genomic Medicine, University of California, San Diego, California 92123, USA
| | - Shimul Chowdhury
- Rady Children's Institute of Genomic Medicine, University of California, San Diego, California 92123, USA
| | - Courtney Thornburg
- Department of Pediatrics, Division of Hematology and Oncology, University of California, San Diego, California 92123, USA
| | - Lauge Farnaes
- Rady Children's Institute of Genomic Medicine, University of California, San Diego, California 92123, USA
| | - David Dimmock
- Rady Children's Institute of Genomic Medicine, University of California, San Diego, California 92123, USA
| | - Stephen F. Kingsmore
- Rady Children's Institute of Genomic Medicine, University of California, San Diego, California 92123, USA
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Rajani NK, Pearce K, Campion T, Salpietro V, Planells M, Chong W, Patankar T, Mankad K. Pediatric stroke: current diagnostic and management challenges. Quant Imaging Med Surg 2018; 8:984-991. [PMID: 30598876 DOI: 10.21037/qims.2018.11.09] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Nikil K Rajani
- Department of Radiology, Imperial Healthcare NHS Trust, London, UK
| | - Kirsten Pearce
- Department of Radiology, Great Ormond Street Hospital, London, UK
| | - Tom Campion
- Department of Radiology, Great Ormond Street Hospital, London, UK
| | | | - Mariana Planells
- Department of Radiology, Hospital General Universitario de Alicante, Alicante, Spain
| | - Winston Chong
- Monash Imaging, Monash University, Melbourne, Australia
| | - Tufail Patankar
- Department of Neuroradiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Kshitij Mankad
- Department of Radiology, Great Ormond Street Hospital, London, UK
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Aronoff SC, Del Vecchio MT. Differential Diagnosis in Pediatrics: A Probabilistic Approach. Hosp Pediatr 2016; 6:504-5. [PMID: 27406854 DOI: 10.1542/hpeds.2016-0053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Stephen C Aronoff
- Department of Pediatrics, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Michael T Del Vecchio
- Department of Pediatrics, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
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15
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Factores de riesgo para accidente vascular encefálico en un hospital universitario. An Pediatr (Barc) 2015; 82:e257. [DOI: 10.1016/j.anpedi.2014.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 10/20/2014] [Indexed: 11/30/2022] Open
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