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August 06, 2013; 81 (6) Article

Role of trauma and infection in childhood hemorrhagic stroke due to vascular lesions

Nilika Shah Singhal, Nancy K. Hills, Stephen Sidney, Heather J. Fullerton
First published July 3, 2013, DOI: https://doi.org/10.1212/WNL.0b013e31829e6f5f
Nilika Shah Singhal
From the Departments of Neurology (N.S.S., N.K.H., H.J.F.), Pediatrics (H.J.F.), and Epidemiology and Biostatistics (N.K.H.), University of California, San Francisco; and Division of Research (S.S.), Kaiser Permanente Northern California, Oakland.
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Nancy K. Hills
From the Departments of Neurology (N.S.S., N.K.H., H.J.F.), Pediatrics (H.J.F.), and Epidemiology and Biostatistics (N.K.H.), University of California, San Francisco; and Division of Research (S.S.), Kaiser Permanente Northern California, Oakland.
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Stephen Sidney
From the Departments of Neurology (N.S.S., N.K.H., H.J.F.), Pediatrics (H.J.F.), and Epidemiology and Biostatistics (N.K.H.), University of California, San Francisco; and Division of Research (S.S.), Kaiser Permanente Northern California, Oakland.
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Heather J. Fullerton
From the Departments of Neurology (N.S.S., N.K.H., H.J.F.), Pediatrics (H.J.F.), and Epidemiology and Biostatistics (N.K.H.), University of California, San Francisco; and Division of Research (S.S.), Kaiser Permanente Northern California, Oakland.
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Citation
Role of trauma and infection in childhood hemorrhagic stroke due to vascular lesions
Nilika Shah Singhal, Nancy K. Hills, Stephen Sidney, Heather J. Fullerton
Neurology Aug 2013, 81 (6) 581-584; DOI: 10.1212/WNL.0b013e31829e6f5f

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Abstract

Objective: Trauma and infection have been postulated as “triggers” for hemorrhage from underlying brain vascular lesions (arteriovenous malformations, cavernous malformations, and aneurysms) in pediatric hemorrhagic stroke. We decided to perform an association study examining these environmental risk factors.

Methods: In this case-control study nested within the cohort of 2.3 million children enrolled in a Northern California integrated health plan (1993–2004), we identified childhood hemorrhagic stroke cases through electronic searches of diagnostic and radiology databases, confirmed through chart review. Three age- and facility-matched controls per case were randomly selected from the study population. Exposure variables were measured using medical records documented before stroke diagnosis. Main outcome measure was hemorrhagic stroke.

Results: Of 132 childhood, non-neonatal hemorrhagic stroke cases, 65 had underlying vascular lesions: 34 arteriovenous malformations, 16 cavernous malformations, and 15 aneurysms. A documented exposure to head and neck trauma in the prior 12 weeks was present in 3 cases (4.6%) with underlying vascular lesions, compared with no controls (p < 0.015). However, all 3 vascular lesions were aneurysms, and traumatic pseudoaneurysms were possible. Recent minor infection (prior 4 weeks) was present in 5 cases (7.7%) and 9 controls (4.6%) (p = 0.34).

Conclusions: Our observed association between trauma and hemorrhagic stroke with a vascular lesion may be explained by traumatic pseudoaneurysms. Neither recent head or neck trauma nor infection appeared to be a “trigger” for pediatric hemorrhagic stroke due to underlying vascular malformations.

GLOSSARY

KPNC=
Kaiser Permanente Northern California;
KPSS=
Kaiser Pediatric Stroke Study

Footnotes

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Received December 4, 2012.
  • Accepted in final form April 29, 2013.
  • © 2013 American Academy of Neurology
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