Acute hemiplegia of childhood

Etiology of stroke in children

Although the risk factors for stroke in children are numerous and differ greatly from the causes of stroke in adults, a thorough diagnostic evaluation can identify one or more risk factors in most patients. Cardiac disorders and hemoglobinopathy are the most common causes of ischemic infarction, whereas various congenital anomalies of the blood vessels or defects in coagulation or platelet function are often found in children with intraparenchymal hemorrhage. More than one risk factor is commonly identified, especially in children with dural venous thrombosis. Identification of the underlying risk factors for cerebrovascular disorders in children is important because many of the risk factors can be treated, reducing the risk of subsequent strokes.

Brain scintigraphy in the diagnosis of the sequelae of head trauma

Computed transaxial tomography (CTT) has become the major imaging tool in the evaluation of any intracerebral lesion, including those due to traumatic injury. Expense and availability sometimes dictate that radionuclide brain scintigraphy (RBS) be performed in place of CTT. Certain situations exist where RBS may be used as a primary tool. These include circumstances where assessment of brain perfusion may be essential, e.g., determination of brain death. Radionuclide cisternography still remains useful in evaluating patients with normal pressure hydrocephalus and cerebrospinal fluid leakage.

Coagulation studies in children and young adults with cerebral ischemic episodes

One hundred and one patients below 45 years and showing objective signs of cerebral ischemia were studied retrospectively for pathogenic factors. Twelve were below 15 years; the male to female ratio was 1:1. Factors known as predisposing (heart disease, hypertension, hyperlipemia, diabetes mellitus or infectious diseases) and other possible factors (e.g. trauma, abuse) were found in 41 patients. Among women using contraceptive pills there might be an increased risk of development of cerebral thrombosis, but the material was not large enough to warrant statistical analysis. In 64 patients one or more abnormal coagulation values were found, the most frequent being a deficient vessel wall fibrinolysis, which was noted in 38%. We therefore consider it worthwhile to investigate the fibrinolytic defence mechanism of the vessel wall in patients with cerebral thrombosis, since it is possible to treat this condition with specific fibrinolytic stimulating agents.