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Childhood haemorrhagic stroke: a 7-year single-centre experience
  1. Lucia Gerstl1,
  2. Katharina Badura1,
  3. Florian Heinen1,
  4. Raphael Weinberger2,
  5. Aurelia Peraud3,
  6. Franziska Dorn4,
  7. Michaela V Bonfert1,
  8. Steffen Berweck1,5,
  9. Finbar J O’Callaghan6
  1. 1 Department of Paediatric Neurology and Developmental Medicine, LMU Munich, University Hospital, Dr. von Hauner Children’s Hospital, Munich, Germany
  2. 2 Division of Epidemiology, LMU Munich, Institute of Social Paediatrics and Adolescent Medicine, Munich, Germany
  3. 3 Department of Paediatric Neurosurgery, University Hospital Ulm, Ulm, Germany
  4. 4 Department of Neuroradiology, LMU Munich, University Hospital, Munich, Germany
  5. 5 Department of Neuropaediatrics and Neurorehabilitation, Schön Klinik Vogtareuth, Vogtareuth, Germany
  6. 6 University College London, Institute of Child Health, Clinical Neuroscience Section, London, UK
  1. Correspondence to Professor Finbar J O’Callaghan, University College London, Institute of Child Health, Clinical Neuroscience Section, London WC1N 1EH, UK; f.o%E2%80%99callaghan{at}


Background In recent years, there has been increasing research interest in improving diagnostic and management protocols in childhood arterial ischaemic stroke (AIS). However, childhood stroke comprises, in approximately equal parts, both arterial ischaemic and haemorrhagic stroke (HS).

Objective The aim of this study was to focus on the aetiology, clinical presentation, treatment and short-term outcome of children with spontaneous intracranial bleeding in a university hospital and elucidate differences to childhood AIS.

Design We performed a retrospective analysis of electronic medical records of children (28 days–18 years) diagnosed with HS between 2010 and 2016.

Results We included 25 children (male child, n=11) with a median age of 8 years 1 month. The most common clinical presentations were vomiting (48%), headache (40%) and altered level of consciousness (32%). In more than half of the patients, HS was caused by vascular malformations. Other risk factors were brain tumour, coagulopathy and miscellaneous severe underlying diseases. Aetiology remained unclear in one child. Therapy was neurosurgical in most children (68%). Two patients died, 5 patients needed further (rehabilitation) treatment and 18 children could be discharged home.

Conclusions HS differs from AIS in aetiology (vascular malformations as number one risk factor), number of risk factors (‘mono-risk’ disease), clinical presentation (vomiting, headache and altered level of consciousness) and (emergency) therapy.

  • intracranial bleeding
  • paediatric
  • haemorrhagic stroke

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  • Contributors LG and FJO: conceptualised and designed the study. FJO: supervised all aspects of the work. LG, KB and FJO: analysis and interpretation of the data. RW: performed statistical analysis. LG: drafted the initial manuscript. FH, AP, FD, MB and SB: interpretation of the data and reviewed and revised the manuscript. All authors approved the final manuscript as submitted.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval The study was approved by the ethics committee and data protection commissioner of the Medical Faculty of the Ludwig-Maximilians-University Munich, Nr 756 – 16 (06-12-16).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.