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AVC hemorrágico : análise retrospetiva de 8 anos numa Unidade de Cuidados Intensivos Pediátricos
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Resumo(s)
Objetivos – O AVC hemorrágico corresponde a cerca de metade dos AVC em idade pediátrica. As taxas de mortalidade e morbilidade associadas são consideráveis, apesar de ser uma patologia pouco frequente (incidência estimada de 1.1:100 000). Esta área tem sido relativamente pouco estudada e não existem guidelines para o seguimento e tratamento destas crianças, pelo que neste trabalho pretende-se efetuar um estudo numa unidade de cuidados terciários, bem como uma breve revisão bibliográfica sobre este tema.
Métodos – Fez-se uma análise retrospetiva na Unidade de Cuidados Intensivos Pediátricos do Hospital de Santa Maria, em Lisboa, num período de 8 anos, com um total de 26 crianças entre os 4 meses e 16 anos de idade. Foi ainda realizado um inquérito telefónico aos pais, que permitiu estimar o prognóstico a longo prazo, aplicando a escala de KOSCHI, e obter uma avaliação das funções cognitivas.
Resultados – A taxa de mortalidade foi de 19.2%, sendo que 72.7% dos sobreviventes tiveram alta hospitalar com sequelas neurológicas. As principais lesões identificadas como causa da hemorragia foram lesões vasculares intracranianas, nomeadamente MAV (53.8%) e aneurismas (23.1%). Verificou-se ainda que os aneurismas foram diagnosticados em crianças mais novas, com menos de 3 anos (p-value 0.003), enquanto as MAV foram principalmente identificadas acima dos 6 anos de idade (p-value 0.021). À data do presente estudo, todas as crianças apresentaram sequelas cognitivas, das quais alterações da aprendizagem, memória, linguagem ou comportamento. Por fim, um GCS inferior a 8 à entrada (p-value 0.027) e hemorragia de localização parenquimatosa (p-value 0.015) estiveram associados a um pior prognóstico.
Conclusão – Neste estudo, confirmou-se sobretudo o impacto negativo do AVC hemorrágico nas funções cognitivas destas crianças, a longo prazo.
Objectives – Hemorrhagic stroke is almost half of overall pediatric stroke. It is not a very common pathology with an estimated incidence of 1.1 in 100 000 children, despite the fact that mortality and morbidity are considerably high. There are relatively few studies and no guidelines for diagnosis and treatment, so the purpose of this study is to do an analysis in a tertiary care unit and a brief review of this subject. Methods – A retrospective analysis of 8 years was made in the Pediatric Intensive Care Unit of Hospital Santa Maria, in Lisbon, and included 26 patients between 4 months and 16 years old. In addition, parents were contacted by telephone and answered questions about long term outcome through KOSCHI’s scale and about possible cognitive impairment. Results – Mortality rate was 19.2% and 72.7% of the children kept neurologic injuries after discharge. Clinical presentation, diagnosis and treatment were similar to previous studies. Intracranial vascular anomalies were the most frequent cause of hemorrhagic stroke: arteriovenous malformations (53.8%) and aneurisms (23.1%). The last ones were mostly identified in children under 3 years old (p-value 0.003) and the first ones were frequently seen after 6 years old (p-value 0.021). Based on parents’ answers, all the patients have cognitive impairments in learning, memory, language or behavior. Finally, a GCS under 8 at the admission (p-value 0.027) and intraparenchymal hemorrhage (p-value 0.015) positively correlated with worst outcome. Conclusion – This study mainly confirms that hemorrhagic stroke as a negative impact in children’s cognitive functions.
Objectives – Hemorrhagic stroke is almost half of overall pediatric stroke. It is not a very common pathology with an estimated incidence of 1.1 in 100 000 children, despite the fact that mortality and morbidity are considerably high. There are relatively few studies and no guidelines for diagnosis and treatment, so the purpose of this study is to do an analysis in a tertiary care unit and a brief review of this subject. Methods – A retrospective analysis of 8 years was made in the Pediatric Intensive Care Unit of Hospital Santa Maria, in Lisbon, and included 26 patients between 4 months and 16 years old. In addition, parents were contacted by telephone and answered questions about long term outcome through KOSCHI’s scale and about possible cognitive impairment. Results – Mortality rate was 19.2% and 72.7% of the children kept neurologic injuries after discharge. Clinical presentation, diagnosis and treatment were similar to previous studies. Intracranial vascular anomalies were the most frequent cause of hemorrhagic stroke: arteriovenous malformations (53.8%) and aneurisms (23.1%). The last ones were mostly identified in children under 3 years old (p-value 0.003) and the first ones were frequently seen after 6 years old (p-value 0.021). Based on parents’ answers, all the patients have cognitive impairments in learning, memory, language or behavior. Finally, a GCS under 8 at the admission (p-value 0.027) and intraparenchymal hemorrhage (p-value 0.015) positively correlated with worst outcome. Conclusion – This study mainly confirms that hemorrhagic stroke as a negative impact in children’s cognitive functions.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2015
Palavras-chave
Acidente vascular cerebral Unidade de cuidados intensivos Pediatria