Pediatric emergency medicine trisk 4000 4000
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Goals of Treatment
Rapid recognition of a child with acute neurologic decline, initial
stabilization, and acquisition of cerebral imaging.
CLINICAL PEARLS AND PITFALLS
Approximately 5% of the population have cerebrovascular
malformations including arteriovenous malformations (AVMs),
cavernous malformations, venous angiomas, and capillary
telangiectasias.
Unruptured aneurysms and certain types of cerebral vascular
malformations are asymptomatic.
Clinical presentations in infants may be nonspecific.
AVMs typically present with spontaneous hemorrhage and/or
seizure.
Clinical Considerations
The presentation of the various types of cerebral vascular malformations
may be insidious. Often, these malformations are asymptomatic. The
presentation of infants may be very nonspecific and include poor feeding,
vomiting, irritability, bulging anterior fontanelle, and altered mental status.
Typical complaints in children include headache that may be localized,
early morning awakening due to headache, progression of headache with
increasing severity and/or frequency, vomiting, visual changes, neck
stiffness, focal neurologic findings, altered mental status, seizure, lethargy,
or obtundation. Signs of impending cerebral herniation include lethargy,
pupillary changes, bradycardia, hypertension, and respiratory depression.
Surgical management of the lesion directly or of elevated intracranial
pressure (ICP) is imperative.
Cerebral Aneurysm
Current Evidence. Aneurysm rupture causing subarachnoid hemorrhage is
the most common presentation of a patient with a cerebral aneurysm,
followed by mass effect and seizures. Less than 10% of pediatric cerebral
