versão On-line ISSN 1683-9803
Introduction: CVA are considered to be rare in children, and their pathophysiology, progression, and treatment is still being analyzed. CVA can be hemorrhagic or ischemic. The sudden onset of acute hemiplegia, frequently accompanied by seizures and altered level of consciousness in a previously healthy child are indicative of CVA. The incidence is from 2.5 to 4.5 per 100,000 annually. Objective: To present the characteristics of CVA in the population of children at the central IPS hospital from July 2004 to July 2006. Materials and Methods: We conducted a retrospective study using review of patient records diagnosed with CVA and admitted to the pediatric neurology section during the study period. We analyzed 13 CVA events. Results: A total of 10 patients who experienced 13 episodes of CVA were recorded; in 3 patients 2 events occurred after a latent period. By age group, distribution was preschool age children 20% (n: 2), school-age children 50% (n: 5), adolescents 30% (n: 3). By gender, distribution was female 5 (50%), and male 5 (50%). Symptoms: headache 92% (12/13), paresis/-plegias 69% (9/13), Broca’s aphasia 23% (3/13), unconsciousness 30% (4/13), seizures 7% (1/13). Sudden onset of symptoms occurred in 53%, while presentation was insidious in 47%. Hospitalization in the pediatric ICU was required in 53% (7/13) of events, in 4/7 for intracranial hypertension and 3/7 due to other complications. Type of CVA: hemorrhagic 77%, ischemic 23%. Of the 3 recurrent cases, 2 were hemorrhagic and 1 ischemic. Areas affected: carotid in 100%; subcortical in 69%; subcortical and cortical in 23%; and 1 intraventricular hemorrhage. Progression: no sequelae were reported in 38%, various degrees of sequelae in 38%, and death in 23%: of the deaths, 2 were from recurrent CVA and one was critical due to extensive bleeding. Causes: arteriovenous malformation (AVM) 23%, vasculitis 23%, Moyamoya disease 7%, afibrinogenemia 7%, carotid dissection 7%, and unidentified etiology 31%. Treatment: general measures in accord with CVA protocols were applied in all cases, while anticoagulants were used in 2 cases and embolectomy was done in 1 case of AVM. Conclusion: Hemorrhagic CVA was the most common form in our study. The vascular area involved in all cases was the carotid. There were equal numbers of patients with and without sequelae at discharge, and the deaths were associated with cases of CVA that were very serious and recurrent.
Palavras-chave : stroke; children.