Aims: To describe the characteristics of cerebrovascular disease (CVD) in patients treated in a paediatric emergency department and to detect clinical differences, depending on whether the condition was ischaemic or haemorrhagic.
Patients and methods: An analytical, observation-based, retrospective study was conducted in the paediatric emergency department of a tertiary care hospital. The sample included patients aged between 1 month and 18 years who were treated in the service over a period of 10 years (January 2001 to December 2011) with a final diagnosis of CVD. Haemorrhages due to traumatic injury or secondary to tumours, thrombosis of the venous sinuses and patients who were not treated in the service were all excluded.
Results: The final sample consisted of 61 patients, 39 (63.9%) of whom were males, with a mean age of 4.6 years (range: 1.3 months-17.5 years). Of them, 26 (42.6%) presented ischaemic CVD and 35 (57.4%) had haemorrhagic CVD. Headache (n = 20; 57.1%; p = 0.008) and vomiting (n = 25; 71.4%; p = 0.001) are more frequent in haemorrhagic CVD, and hemiparesis (n = 17; 65.4%; p < 0.001) and facial palsy (n = 7; 26.9%; p = 0.001) in ischaemic CVD. The main causes of haemorrhagic CVD are arteriovenous malformations (n = 17; 38.6%) and the ischaemic ones are triggered by arteriopathies (n = 6; 42.3%). On discharge from hospital, 27 (44.3%) presented different degrees of disability and 6 (9.8%) died.
Conclusions: CVD is a rare entity, although it presents a high morbidity and mortality rate. Haemorrhagic CVD is seen to predominate slightly and it is observed how haemorrhagic CVD presents more often with signs of intracranial hypertension, while the ischaemic form tends to have more neurological focus.
Title: Enfermedad cerebrovascular en pediatria. Experiencia de un servicio de urgencias.
Objetivos. Describir las caracteristicas de la enfermedad cerebrovascular (ECV) en pacientes atendidos en un servicio de urgencias pediatrico y detectar diferencias clinicas segun sea isquemica o hemorragica. Pacientes y metodos. Estudio retrospectivo, analitico observacional, realizado en el servicio de urgencias pediatrico de un hospital de tercer nivel. Se incluyen pacientes entre 1 mes y 18 años de edad atendidos en el servicio durante 10 años (enero de 2001 a diciembre de 2011) con diagnostico final de ECV. Se excluyen las hemorragias por traumatismos o secundarias a tumores, las trombosis de senos venosos y los pacientes no atendidos en el servicio. Resultados. Se incluyen 61 pacientes, 39 (63,9%) de sexo masculino, con una mediana de edad de 4,6 años (rango: 1,3 meses-17,5 años). De ellos, 26 (42,6%) presentan ECV isquemica y 35 (57,4%) ECV hemorragica. La cefalea (n = 20; 57,1%; p = 0,008) y los vomitos (n = 25; 71,4%; p = 0,001) son mas frecuentes en la ECV hemorragica, y la hemiparesia (n = 17; 65,4%; p < 0,001) y la paralisis facial (n = 7; 26,9%; p = 0,001), en la ECV isquemica. Las principales causas de la ECV hemorragica son las malformaciones arteriovenosas (n = 17; 38,6%), y las de la ECV isquemica, las arteriopatias (n = 6; 42,3%). Al alta, 27 (44,3%) presentaban diferentes grados de discapacidad y 6 (9,8%) fallecieron. Conclusiones. La ECV es una entidad poco frecuente, aunque presenta una elevada morbimortalidad. Se observa un ligero predominio de la ECV hemorragica y se comprueba que la ECV hemorragica se presenta mas con signos de hipertension intracraneal, y la isquemica, con focalidad neurologica.