[Clinical and radiological features of cerebral venous thrombosis in a children cohort]. / Características clínicas y radiológicas de una cohorte de niños con trombosis venosa intracraneal.

INTRODUCTION: Cerebral venous thrombosis (CVT) is an uncommon and poorly studied condition in the pediatric population. OBJECTIVES: To describe and compare the clinical and radiological features of non-neonatal children with CVT according to age and to analyze their association with functional impairment or mortality at hospital discharge. METHODOLOGY: An observational cohort study of chil dren older than 30 days with a first CVT diagnosed with imaging/venography by magnetic resonance (IMR/VMR). We measure functionality with the modified Rankin scale defining marked impairment with 3 to 5 points. We used U-Mann-Whitney test to compare ages averages between groups with and without the different studied variables (significance < 0.05). We used logistic regression analyses to estimate the risk of adverse outcome for each variable expressed in Odds Ratios (ORs) and 95% confidence intervals (CI). RESULTS: Among 21 patients recruited, 42.8% were girls, median age 6.27 years (Interquartile range: 0.74-10). The average age was lower in children with diagnostic delay > 48 hours (p = 0.041), score < 12 in the Glasgow coma scale (p = 0.013), seizures (p = 0.041), sinus rectus thrombosis (p = 0.011), and intracranial hemorrhage (p = 0.049); while it was significantly higher in children with intracranial hypertension syndrome (p = 0.008). The presence of some chro nic systemic condition (OR = 11.2; CI = 1.04-120.4), deep CVT (OR = 14; CI = 1.3-150.8), and brain ischemia (OR = 15.8; CI = 1.4-174.2) was associated with marked functional impairment or mor tality at discharge. CONCLUSIONS: Clinical and radiological features of CVT are age-related. Chronic illnesses, deep venous system involvement, and brain ischemia predict adverse short-term outcomes.

Características clínicas y radiológicas de una cohorte de niños con trombosis venosa intracraneal / Clinical and radiological features of cerebral venous thrombosis in a children cohort

Resumen: Introducción: La trombosis venosa intracraneal (TVI) es una condición infrecuente y poco estudiada en población pediátrica. Objetivos: Describir y comparar características clínicas/radiológicas de ni ños no neonatos con TVI según edad y analizar la asociación de estas variables con deterioro funcio nal al alta o mortalidad aguda. Metodología: Estudio observacional de una cohorte de niños > 30 días con una primera TVI diagnosticada con imágenes/venografía por resonancia magnética encefálica. Medimos funcionalidad con la escala modificada de Rankin definiendo compromiso funcional mar cado con 3 a 5 puntos. Comparamos los promedios de edades entre grupos con y sin las diferentes variables estudiadas con la prueba U-Mann-Whitney (significancia < 0,05). Realizamos análisis de regresión logística para estimar el riesgo de resultado adverso de cada variable expresado en Odds Ra tios (ORs) e intervalos de confianza (IC) al 95%. Resultados: De 21 pacientes, 42.8% eran niñas, me diana de edad 6,27 años (rango intercuartil: 0,74-10). El promedio de edad fue menor en niños con retardo diagnóstico > 48 h (p = 0,041), puntaje < 12 en la escala coma de Glasgow (p = 0,013), crisis epilépticas (p = 0,041), trombosis de seno recto (p = 0,011) y hemorragia intracraneal (p = 0,049); mientras que fue mayor en niños con síndrome de hipertensión endocraneal (p = 0,008). La presen cia de alguna condición crónica sistémica (OR = 11,2; IC = 1,04-120,4), TVI profunda (OR = 14; IC = 1,3-150,8) e infarto encefálico (OR = 15,8; IC = 1,4-174,2) se asoció a compromiso funcional marcado o mortalidad al alta. Conclusiones: Las características clínicas/radiológicas de la TVI varían según la edad. Las patologías crónicas, compromiso del sistema venoso profundo e infarto encefálico predicen mal pronóstico a corto plazo.

Abstract: Introduction: Cerebral venous thrombosis (CVT) is an uncommon and poorly studied condition in the pediatric population. Objectives: To describe and compare the clinical and radiological features of non-neonatal children with CVT according to age and to analyze their association with functional impairment or mortality at hospital discharge. Methodology: An observational cohort study of chil dren older than 30 days with a first CVT diagnosed with imaging/venography by magnetic resonance (IMR/VMR). We measure functionality with the modified Rankin scale defining marked impairment with 3 to 5 points. We used U-Mann-Whitney test to compare ages averages between groups with and without the different studied variables (significance < 0.05). We used logistic regression analyses to estimate the risk of adverse outcome for each variable expressed in Odds Ratios (ORs) and 95% confidence intervals (CI). Results: Among 21 patients recruited, 42.8% were girls, median age 6.27 years (Interquartile range: 0.74-10). The average age was lower in children with diagnostic delay > 48 hours (p = 0.041), score < 12 in the Glasgow coma scale (p = 0.013), seizures (p = 0.041), sinus rectus thrombosis (p = 0.011), and intracranial hemorrhage (p = 0.049); while it was significantly higher in children with intracranial hypertension syndrome (p = 0.008). The presence of some chro nic systemic condition (OR = 11.2; CI = 1.04-120.4), deep CVT (OR = 14; CI = 1.3-150.8), and brain ischemia (OR = 15.8; CI = 1.4-174.2) was associated with marked functional impairment or mor tality at discharge. Conclusions: Clinical and radiological features of CVT are age-related. Chronic illnesses, deep venous system involvement, and brain ischemia predict adverse short-term outcomes.

Factores de riesgo para accidente vascular encefálico en un hospital universitario. Respuesta de los autores / Risk factors for cerebrovascular accident in a university hospital. Author's response

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Factores de riesgo para accidente vascular encefálico en un hospital universitario / Cerebrovascular risk factors seen in a university hospital

INTRODUCCIÓN: Los factores de riesgo (FR) para accidente vascular encefálico (AVE) pediátrico difieren del adulto e incluyen un amplio rango de enfermedades, como pueden ser cardiopatías, infecciones, leucemias y errores congénitos del metabolismo. OBJETIVOS: Describir FR en AVE isquémico en población pediátrica y explorar asociación de los FR con edad, sexo y tipo de AVE. Pacientes y método: Se analizaron 114 casos pediátricos con AVE isquémico ocurridos entre enero del 2003 y julio del 2012. Los FR se estratificaron en 6 categorías, los AVE isquémicos se clasificaron como arterial y venoso. Se compararon los FR con edad, sexo y tipo de infarto (chi al cuadrado y odds ratio). RESULTADOS: La mediana de edad fue 2,5 años, 74 (62,2%) hombres. El 7,9% de los pacientes no tenía FR identificable y el 67% tenía más de uno. La mayor frecuencia de FR fue: enfermedades sistémicas agudas (56,1%), cardiopatías (35,1%) y enfermedades crónicas sistémicas (29,8%). Hubo asociación estadísticamente significativa entre FR enfermedad sistémica aguda y edad menor de 5 años (p < 0,001) y entre enfermedad crónica sistémica y edad mayor o igual a 5 años (p < 0,02). El FR cardiopatía se asoció a infarto arterial (p < 0,05) y el FR enfermedad aguda de cabeza y cuello con infarto venoso (p < 0,05). CONCLUSIONES: Los FR de AVE isquémico en la población pediátrica son múltiples y algunos de ellos se asocian a edades específicas y tipo de AVE. La detección de estos factores permitirá la prevención primaria en la población de riesgo así como un diagnóstico y tratamiento precoz, haciendo igualmente posible la prevención de recurrencias

INTRODUCTION: Risk factors (RF) in pediatric stroke differ from those of adults, and they include a wide range of diseases such as heart disease, infections, leukemias, and inborn errors of metabolism. OBJECTIVES: To describe RF for ischemic stroke in a pediatric population, and to examine the relationship of RF with age, sex and type of stroke. PATIENTS AND METHODS: An analysis was made of database of 114 children and adolescents with ischemic stroke from January 2003 to July 2012. Risk factors were stratified into 6 categories and ischemic strokes were classified as arterial and venous. We compared the RF with age, sex, and type of stroke (chi2 and OR). RESULTS: The median age was 2.5 years, with 74 (62.2%) males. No RF was identified in 7.9% of patients, and 67% had more than one RF. The most common RF were acute systemic diseases (56.1%), heart disease (35.1%), and chronic systemic diseases (29.8%). There was a statistically significant association between acute systemic disease and age less than 5 years (P<0.001), and between chronic systemic disease and age 5 years or more (P<.02). The RF of heart disease was associated with arterial infarction (P<0.05), and the acute head and neck disease RF was associated with venous infarction (P<0.05). CONCLUSIONS: The RF for ischemic stroke are multiple in the pediatric population, and some of them are associated with a specific age and type of stroke. The detection of these factors may help in the primary prevention of people at risk, an early diagnosis, and treatment and prevention of recurrences

[Cerebrovascular risk factors seen in a university hospital]. / Factores de riesgo para accidente vascular encefálico en un hospital universitario.

INTRODUCTION: Risk factors (RF) in pediatric stroke differ from those of adults, and they include a wide range of diseases such as heart disease, infections, leukemias, and inborn errors of metabolism. OBJECTIVES: To describe RF for ischemic stroke in a pediatric population, and to examine the relationship of RF with age, sex and type of stroke. PATIENTS AND METHODS: An analysis was made of database of 114 children and adolescents with ischemic stroke from January 2003 to July 2012. Risk factors were stratified into 6 categories and ischemic strokes were classified as arterial and venous. We compared the RF with age, sex, and type of stroke (chi2 and OR). RESULTS: The median age was 2.5 years, with 74 (62.2%) males. No RF was identified in 7.9% of patients, and 67% had more than one RF. The most common RF were acute systemic diseases (56.1%), heart disease (35.1%), and chronic systemic diseases (29.8%). There was a statistically significant association between acute systemic disease and age less than 5 years (P<.001), and between chronic systemic disease and age 5 years or more (P<.02). The RF of heart disease was associated with arterial infarction (P<.05), and the acute head and neck disease RF was associated with venous infarction (P<.05). CONCLUSIONS: The RF for ischemic stroke are multiple in the pediatric population, and some of them are associated with a specific age and type of stroke. The detection of these factors may help in the primary prevention of people at risk, an early diagnosis, and treatment and prevention of recurrences.