Spontaneous Intracranial Hemorrhage In Infants:A Clinical Analysis Of 131 Cases

Objective:To explore clinical features of the etiology,imaging characteristics,complications and prognosis of spontaneous intracranial hemorrhage in infants.Methods:Clinical data including the etiology,clinical manifestations,imaging results,complications,treatment methods and prognosis of infants(≤3 years old)with spontaneous intracranial hemorrhage admitted to our department of neurosurgery from January 2011 to December 2018 were collected for analysis.Results:The causes of intracranial hemorrhage in this cohort include is including delayed vitamin K deficiency(72 cases,54.9%),arteriovenous malformations(16 cases,12.2%),hemophilia(15 cases,11.4%),unexplained coagulation dysfunction(9 cases,6.9%),cavernous hemangioma(5 cases,3.8%),hypoxic ischemic encephalopathy(4 cases,3.1%),brain tumor stroke(3 cases,2.3%),cerebral paragonimiasis and aneurysm(both 2 cases,1.5%),and acute leukemia,hemophilic syndrome and Sturge-Weber syndrome(all 1 case,0.8%).All cases were diagnosed with intracranial hemorrhage by CT scanning or MRI.Among them,34 cases were suspected to be cerebrovascular disease,and CTA examination was performed on all of them.CTA suggested cerebrovascular disease in 19 cases.The complications included convulsion or seizure(86 cases,65.6%),anemia(77 cases,58.8%),secondary infections(46 cases,35.1%),cerebral hernia(32 cases,24.4%),cerebral edema(28 cases,21.4%),cerebral infarction(27 cases,20.6%),hydrocephalus(26 cases,19.8%),respiratory failure(14 cases,10.6%)and status convulsion(9 cases,6.9%).There were43 cases undergone surgical treatment,and 88 cases received non-surgical treatment.GOS score was used for prognosis,and 100 patients(76.3%)in this group had a good prognosis.According to binary logistic regression analysis,cerebral edema(OR=5.794),cerebral hernia(OR=11.326)and respiratory failure(OR=8.028)were risk factors for poor prognosis(P<0.05).In addition to one case of death,the remaining follow-up period was more than two years after discharge.GOS score results showed that the scores of the children were significantly improved after 2 years of discharge compared with those at discharge(P<0.05),and the prognosis was significantly improved.Conclusion:The most common cause of spontaneous intracranial hemorrhage in infants is delayed vitamin K deficiency.If the cause of hemorrhage is suspected to be cerebrovascular disease,CTA examination should be conducted as early as possible.Clinically,symptomatic treatment should be carried out as early as possible to reduce complications and the disease can obtain a good prognosis after active treatment.