Stroke in Children and Young Adults: Expert Consult - Online and Print

349 Pages·2009·7.82 MB·English

by  Jose Biller MD FAAN FACP FAHA

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STROKEINCHILDRENANDYOUNGADULTS ISBN:978-0-7506-7418-8
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LibraryofCongressCataloging-in-PublicationData
Biller,Jose´.
Strokeinchildrenandyoungadults/Jose´ Biller.--2nded.
p.;cm.
Includesbibliographicalreferencesandindex.
ISBN-13:978-0-7506-7418-8
ISBN-10:0-7506-7418-0
1.Cerebrovasculardiseaseinchildren. 2.Cerebrovasculardisease. I.Title.
[DNLM: 1.Stroke. 2.Adolescent. 3.Child. 4.Infant. 5.YoungAdult. WL355B597s2009]
RJ496.C45S772009
618.92081--dc22
2008054235
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This book is dedicated to the memory of Dr. William DeMyer. Known and loved by many as
preeminent neuroanatomist, erudite teacher, tireless advisor, compassionate caregiver,
gregarious sportsman, and consummate family man. He will be missed
by those whom he touched with any facet of his multidimensional life.
CONTRIBUTORS
Thomas J. Altstadt, MD
Neurological Surgery, Medford Neurological and Spine Center, Medford,
Oregon
Jose´ Biller, MD, FACP, FAAN, FAHA
ProfessorandChairman,DepartmentofNeurology,LoyolaUniversityChicago,
Stritch School of Medicine, Maywood, Illinois
Rima M. Dafer, MD, MPH
Associate Professor, Department of Neurology, Loyola University Chicago,
Stritch School of Medicine, Maywood, Illinois
William E. DeMyer, MD
Professor Emeritus of Child Neurology, Indiana University;
Riley Hospital for Children, Indianapolis, Indiana
Meredith R. Golomb, MD, MSc
Assistant Professor, Department of Neurology, Division of Pediatric Neurology,
Indiana University School of Medicine; Riley Hospital for Children,
Indianapolis, Indiana
Lotfi Hacein-Bey, MD
Professor, Departments of Radiology and Neurosurgery and
Director, Neuroradiology and Interventional Neuroradiology,
Loyola University Medical Center, Chicago, Illinois
Betsy B. Love, MD
Adjunct Clinical Associate Professor, Department of Neurology, Loyola
University Chicago, Stritch School of Medicine, Maywood, Illinois
James F. Meschia, MD
Professor and Director, Cerebrovascular Division, Department of Neurology,
Mayo Clinic, Jacksonville, Florida
Thomas C. Origitano, MD, PhD, FACS
Professor and Chair, Department of Neurological Surgery, Co-Director, The
Center for Cranial Base Surgery, Director, Loyola Neuroscience Service Line,
Loyola University Medical Center, Maywood, Illinois
Hema Patel, MD
Associate Professor, Department of Neurology, Section of Pediatric Neurology,
Indiana University School of Medicine; Associate Professor, Department of
vii
viii Contributors
Neurology, Section of Pediatric Neurology, Clarian Health Partners – James Whitcomb Riley
Hospital for Children, Indianapolis, Indiana
Michael B. Pritz, MD, PhD
Professor, Department of Neurological Surgery and Director, Cerebrovascular and Skull Base
Surgery, Indiana University School of Medicine; Attending Neurosurgeon, University
Hospitals, Indianapolis, Indiana
Richard B. Rodgers, MD
Assistant Professor, Department of Neurological Surgery, Indiana University School of
Medicine, Indianapolis, Indiana
Michael J. Schneck, MD
Associate Professor of Neurology and Neurosurgery, Department of Neurology,
Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois
Eugene R. Schnitzler, MD
Associate Professor of Neurology and Pediatrics and Chief, Division of Pediatric Neurology,
Loyola University Chicago, Stritch School of Medicine; Department of Neurology and
Pediatrics, Loyola University Medical Center, Maywood, Illinois
Mitesh V. Shah, MD, FACS
Associate Professor and Co-Director, Skull Base Surgery, Department of Neurosurgery,
Indiana University, Indianapolis, Indiana
Deborah K. Sokol, MD, PhD
Associate Professor of Clinical Neurology, Section of Pediatrics, Indiana University School of
Medicine; Pediatric Neurologist, Riley Hospital for Children, Indianapolis, Indiana
Marc G. Weiss, MD
Associate Professor, Department of Pediatrics and Director, Division of Neonatology,
Loyola University Chicago, Stritch School of Medicine; Medical Director, Neonatal Intensive
Care Unit, Ronald McDonald Children’s Hospital of Loyola University Medical Center,
Maywood, Illinois
FOREWORD
Towriteaforewordtoasecondeditionisinmanywaysmucheasierthanfora
first. One responds to success rather than predicting it. Fourteen years ago,
Professor James Toole pointed out in the “foreword” the need for and the
potential importance of this book, Stroke in Children and Young Adults. He
concluded with the statement that “Professor Biller and his colleagues have
authored a text that will stand the test of time.” Obviously he was correct.
The success of the first edition established the need for and importance of
the publication and, for 14 years, it stood the test of time. He also predicted
that the new generation of clinical neuroscientists specializing in the preven-
tion of and therapy for stroke would carry on to new heights of accomplish-
ment. Again, he proved to be correct. Since 1994, this new generation has
added so much to our understanding of stroke in children and young adults
that this new edition is a necessity.
ProfessorBillerandhiscolleaguesrespondedtothischallengeandextensively
revised and added to the material originally published bringing this document
up to date and including information published in the early part of 2008. This
has resulted in extensive rewriting of the original 14 chapters and the addition
ofthreenewchapters.
This isindeedastate-of-the-artpublication. Forexample,most oftherefer-
encesarepublishedafter1994.Asonereviewsthegalleys,oneisstruckbyhow
much has been added to our knowledge during this time. In addition to many
of the original contributors, others have been added and have continued the
high quality of work produced in the first edition.
The additional three chapters extend and add information to that included
in the first edition. In particular, the chapter, Applied Anatomy of the Brain
Arteries, by William DeMyer should serve as an invaluable addition for any
understanding of vascular supply and clinical syndromes related to the brain
arteries and for a reference in the future. It is unlikely that someone not work-
ing primarily in stroke would keep all of these details constantly in mind. As
this book was in the final editing process, Dr. DeMyer died at the age of
84 years. Although physically incapacitated during his final few months, he
continued to work and contribute in many areas of Neurology and completed
hisfinal book,TakingtheClinicalHistory:ElicitingSymptoms, EthicalFounda-
tions,afewdaysbeforehisdeath.Thededicationofthisbooktohim,expresses
the high regard that Biller, his colleagues, and all who know of his many
ix
x Foreword
contributions and his work ethic have for serve as the state-of-the-art source for
him.ItisalsoareflectionofProfessorBiller’s understanding of Stroke in Children and
good judgment in selecting outstanding Young Adults.
contributors for inclusion in this volume. Mark L. Dyken, M.D.
Let us hope that the continued rapid Professor Emeritus of Neurology
acquisition of knowledge makes it necessary Department of Neurology
for a third edition long before 14 years. In Indiana University School of Medicine
the meantime, this updated volume will Indianapolis, Indiana
PREFACE TO THE
FIRST EDITION
Cerebrovasculardiseaseinchildrenandyoungadultsrepresentsachallengeto
clinicalneurologists.Cerebrovasculardiseasespansallmedicalspecialties,and
most clinicians are familiar with the catastrophic consequences of these
disorders.
Thisbookaddressesthepracticalneedsofhouseofficers,neurologists,neu-
rosurgeons, as well as those of specialists in pediatrics, internal medicine,
andfamilypracticewhocareforawidevarietyofyoungpatientswithischemic
and hemorrhagic cerebrovascular disease. Stroke in Children and Young
Adults provides a framework of clinical decision making and management of
bothcommonlyandrarelyencounteredcerebrovasculardisordersintheyoung
population.
Afteranoverviewofstroketypes,riskfactors,prognosis,anddiagnosticstrat-
egies in neonates, children, and young adults, the ischemic stroke subtypes
are discussed separately to familiarize the reader with relevant issues in
atherosclerotic cerebral infarction, non-atherosclerotic cerebral vasculopa-
thies, cardiac disorders, and disorders of hemostasis. Additionally, a thorough
discourse of miscellaneous topics—migraine and stroke, stroke and preg-
nancy, rare genetic disorders associated with stroke, and cerebral venous
thrombosis—is included. The final sections contain further insight into the
practical and clinical information relative to intracerebral and subarachnoid
hemorrhage.
We hope our readers find this book useful and that it enhances their ability
to optimize care for the young stroke patient.
Acknowledgments
I owe a special debt to my family for their support during this project. In
particular, I wish to express endless gratitude to my wife Ce´lika for her unfail-
ing patience and her assistance in organizing and preparing this book for
publication.
xi
PREFACE
Cerebrovascular disease in children and young adults accounts for 5% to 10%
of all stroke cases and remains one of the top ten causes of childhood death,
encompassing a broad range of causes and risk factors. This often represents
a diagnostic and therapeutic challenge to clinicians with an average recog-
nition time of 35.7 hours for the younger patients. Considerable progress
has been made in our understanding of the incidence, etiology, diagnosis,
and treatment of stroke in children and young adults. Even with this progress,
however, clinicians, parents, patients, and caregivers can sometimes become
disappointedorfrustrated because thecause ofthediseasemay remainunde-
termined in a considerable percentage of patients and a uniform approach to
treatment is often lacking. Cerebrovascular disease occurring in this age cate-
gory spans multiple medical specialties. Clinicians caring for young stroke
victimsarebecomingincreasinglyfamiliarwiththecatastrophicconsequences
of these disorders which include not only a dramatic decline in the quality of
life among survivors but potential socioeconomic consequences as well. This
edition serves to provide an updated and more expansive resource that will
be instrumental to clinical practices focusing on cerebrovascular disease in
young people. It continues to address the practical needs of house officers,
neurologists,andneurosurgeonsaswellastheneedsofspecialistsinthefields
of pediatrics, internal medicine, family practice, emergency medicine, nursing
and other allied health professionals who care for a wide variety of young
patients with ischemic and hemorrhagic cerebrovascular disease.
JustasintheFirstEdition,thebookbeginswithanoverviewofstroketypes,
risk factors, prognosis, and diagnostic strategies in neonates, children and
young adults. This is followed by a new, highly detailed and thoroughly illu-
strated chapter on the applied anatomy of brain arteries, which is presented
inordertofamiliarizethereaderwiththerelevantneuroanatomicalcorrelation
of symptoms and signs pertaining to important stroke syndromes. Chapters 3
and 4 contain an expanded discussion on the epidemiology, clinical presenta-
tion, evaluation, and treatments of stroke during the first 18 years of life and
the individualized approach to neonates, children and young adults. The next
threechaptersprovide adetaileddiscussiononatheroscleroticcerebralinfarc-
tion, non-atherosclerotic vasculopathies, and cardiac disorders and strokes
occurring in children and young adults. There are separate and fully updated
chapterspertaining to cerebralinfarctionand migraines, aswell as hemostatic
disorders presenting as stroke. Since pregnancy-associated stroke remains a
major cause of serious morbidity and mortality, a comprehensive review of
pregnancyassociatedischemicandhemorrhagic strokesisdiscussedindepen-
dently. Similarly, as rare genetic disorders can lead to stroke, and diagnosis
of these inherited conditions have important implications for the patient
regarding stroke and his family, a concise review of rare genetic disorders that
are associated with stroke is contained in Chapter 11. Cerebral venous
xiii
xiv Preface
thrombosis represents less than 1% to 2% of focuses on pediatric central nervous sys-
all stroke cases and although patients often tem (CNS) vascular malformations (a com-
present later in the course of their disease, mon cause of non-traumatic intracerebral
it is more easily diagnosed with the advent hemorrhage in this age group), and the
of modern neuroimaging. Chapter 12 covers otheronthevarioustypesofspinalcordvas-
theepidemiology,clinicalpresentation,diag- cular malformations in children and young
nosis, and management of thrombosis of adults.
the cerebral veins and sinuses along with Wehope thereadersofStroke inChildren
the various etiologies which contribute to and Young Adults, Second Edition, will find
its development. Subsequent chapters con- it to be current and clinically beneficial. In
tain further insights into neonatal intracra- addition, we hope that the knowledge about
nial hemorrhage (a significant problem in the disorders covered in this book will be
neonatal intensive care units), spontaneous utilized to benefit the patients who have
intracerebral hemorrhage (which accounts helped us increase our understanding of
for about 15% of all strokes), and subarach- stroke within this age group.
noid hemorrhage in young adults. Finally,
there are two new chapters—one of which Jose Biller, MD