5th Edition of International Neurology Conference 2026

Abstract

Introduction: Hemorrhagic stroke (HS) in children is a serious condition with significant morbidity and mortality. Acute symptomatic epileptic seizures (ASyS) and post-stroke epilepsy (PSE) are common complications that can worsen outcomes. Identifying risk factors for ASyS, PSE, mortality, and long-term neurological deficits is crucial for optimizing management.

Hypothesis: We hypothesized that younger age, specific etiologies (e.g., arteriovenous malformation [AVM], aneurysm, coagulopathy), hematoma volume and location, and the presence of ASyS are significant predictors of adverse outcomes, including ASyS development, PSE, mortality, and poor functional and cognitive recovery in children with HS.

Methods: The study included 69 children with HS (60.9% male, median age 128 months). Patients were divided into groups based on ASyS presence (HS ASyS+, n=24, 34.8%), PSE development (n=14, 22.6% of 62 with follow-up), and mortality (n=4, 5.8%). Clinical characteristics, neuroimaging findings (hematoma volume, location, mass effect), consciousness level (GCS), stroke severity (pedNIHSS), AVM grade (Spetzler-Martin), and outcomes (modified Rankin Scale [mRS] for motor deficit, PSOM for cognitive deficit) were analyzed. Statistical methods included ROC analysis, regression, and correlation tests.

Results: The only significant risk factor for ASyS was younger age at HS (threshold 63 months; OR 10.3, 95% CI 2.79-37.7). A higher Spetzler-Martin grade in patients with AVM was the sole predictor of PSE (p=0.05). The LANE scale showed moderate utility for predicting PSE (AUC: sensitivity 57.45%, specificity 78.57% at ≥4 points). Mortality was associated with larger hematoma volume (>40 ml, p=0.002), ruptured cerebral artery aneurysm (p=0.02), presence of subarachnoid hemorrhage (p=0.024). Among survivors (n=62, median follow-up 34.5 months), favorable functional outcomes (mRS 0-2) were seen in 96.8%. Poor motor and cognitive outcomes correlated with larger absolute and relative hematoma volume, midline shift, lower GCS, higher pedNIHSS, and emergency surgery. Ruptured aneurysm and greater hematoma-to-brain volume ratio were independent predictors of motor disability and PSE were risk factors for cognitive deficit.

Conclusions: Younger age is the key risk factor for ASyS in pediatric HS. Hematoma volume and ruptured aneurysm predict mortality. Long-term outcomes depend on hematoma volume, timing of surgery, and development of PSE. For the first time scales for adult patients (CAVE, CAVS, LANE) were validated for children. The LANE scale may be helpful for PSE risk assessment but requires modification for children.