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Khatri D, Zampolin R, Behbahani M, Kobets A, Lax D, Manwani D, Benitez S, Toma A, Holland R, Brook A, Lee SK. Pediatric brain aneurysms: a review of 1458 brain MR angiograms. Childs Nerv Syst 2023; 39:3249-3254. [PMID: 37185695 DOI: 10.1007/s00381-023-05967-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 04/17/2023] [Indexed: 05/17/2023]
Abstract
PURPOSE To evaluate clinical and imaging characteristics of pediatric brain aneurysms. MATERIALS AND METHODS A retrospective review of 1458 MR angiograms of pediatric patients (≤18 years old) obtained between 2006 and 2021 was performed. A non-infundibular arterial luminal outpouching larger than 1mm in size was identified as an "Intracranial aneurysm." Patient demographics, clinical presentations, and predisposing risk factors, including family history and underlying medical conditions, were reviewed. MRA images were analyzed for aneurysm location, number, maximum diameter, and interval changes on follow-up. RESULTS Forty-nine (3.3%) patients (30 females, 19 males) with 64 intracranial aneurysms were identified with an average age of 13.71 ± 3.67 years. Eleven (22.4%) patients had multiple aneurysms. An underlying systemic illness was observed in 81.6% (40/49) cases, with sickle cell disease as the most frequent (25/49, 51%) diagnosis. A first-degree family history of intracranial aneurysms was recognized in 36/1458 (2.5%) patients. However, no intracranial aneurysm was found in this group. While 02/49 (4%) patients presented with acute SAH, headache was the most common (16/49, 32.7%) symptom at presentation in unruptured cases. The majority (47/64, 73.4%) of the aneurysms were located in the anterior circulation, with the ICA ophthalmic segment being most frequently (24/47, 51%) involved. Most (54/64, 84.4%) aneurysms were smaller than 4mm in size at the time of diagnosis. At least one follow-up MRA was obtained in 72.3% (34/47) of the unruptured aneurysms cohort. There was no change in the aneurysm size and morphology in 31/34 (91.2 %) patients over an average imaging follow-up of 39.6 months. Three (6%) patients demonstrated an interval increase in the aneurysm size. SAH patients (n=2) and two unruptured aneurysm patients with an interval increase in size were successfully treated with endovascular techniques. CONCLUSION Female predominance with a higher frequency of small and unruptured intracranial aneurysms was recognized in our cohort. A higher incidence of an underlying systemic illness, especially sickle cell disease, was also noted. Most intracranial aneurysms in children appear to remain stable. However, there seems to be the risk of an aneurysm size increase which warrants regular clinical and imaging follow-up.
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Affiliation(s)
- Deepak Khatri
- Department of Radiology, Montefiore Medical Center and Children's Hospital at Montefiore (CHAM), Bronx, New York, 10467, USA
- Department of Neurosurgery, Montefiore Medical Center and Children's Hospital at Montefiore (CHAM), Bronx, New York, 10467, USA
| | - Richard Zampolin
- Department of Radiology, Montefiore Medical Center and Children's Hospital at Montefiore (CHAM), Bronx, New York, 10467, USA
| | - Mandana Behbahani
- Department of Neurosurgery, Montefiore Medical Center and Children's Hospital at Montefiore (CHAM), Bronx, New York, 10467, USA
| | - Andrew Kobets
- Department of Neurosurgery, Montefiore Medical Center and Children's Hospital at Montefiore (CHAM), Bronx, New York, 10467, USA
| | - Daniel Lax
- Department of Neurology, Montefiore Medical Center and Children's Hospital at Montefiore (CHAM), Bronx, New York, 10467, USA
| | - Deepa Manwani
- Department of Pediatrics, Montefiore Medical Center and Children's Hospital at Montefiore (CHAM), Bronx, New York, 10467, USA
| | - Steven Benitez
- Department of Radiology, Montefiore Medical Center and Children's Hospital at Montefiore (CHAM), Bronx, New York, 10467, USA
| | - Aureliana Toma
- Department of Radiology, Montefiore Medical Center and Children's Hospital at Montefiore (CHAM), Bronx, New York, 10467, USA
| | - Ryan Holland
- Department of Neurosurgery, Montefiore Medical Center and Children's Hospital at Montefiore (CHAM), Bronx, New York, 10467, USA
| | - Allan Brook
- Department of Radiology, Montefiore Medical Center and Children's Hospital at Montefiore (CHAM), Bronx, New York, 10467, USA
- Department of Neurosurgery, Montefiore Medical Center and Children's Hospital at Montefiore (CHAM), Bronx, New York, 10467, USA
| | - Seon-Kyu Lee
- Department of Radiology, Montefiore Medical Center and Children's Hospital at Montefiore (CHAM), Bronx, New York, 10467, USA.
- Department of Neurology, Montefiore Medical Center and Children's Hospital at Montefiore (CHAM), Bronx, New York, 10467, USA.
- Department of Neurosurgery, Montefiore Medical Center and Children's Hospital at Montefiore (CHAM), Bronx, New York, 10467, USA.
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Lee W, Rhim JK, Joo JD, Huh JS, Sim KB, Chung YN. Ruptured Fusiform Anterior Cerebral Artery Aneurysm in an Infant : Case Report and a Literature Review. J Korean Neurosurg Soc 2023; 66:743-747. [PMID: 37496405 PMCID: PMC10641425 DOI: 10.3340/jkns.2022.0201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 02/23/2023] [Accepted: 03/11/2023] [Indexed: 07/28/2023] Open
Abstract
Ruptured intracranial aneurysms in infants are rare and infantile fusiform anterior cerebral artery (ACA) aneurysms are much rarer. In this report, we described the case of a 7-month-old infant with a ruptured fusiform ACA aneurysm who presented with seizure and underwent endovascular treatment. The patient was initially in a coma and the neurologic condition did not improve after treatment. The clinical characteristics of the case and literature review were discussed.
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Affiliation(s)
- Wonseok Lee
- Department of Neurosurgery, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Korea
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jong-Kook Rhim
- Department of Neurosurgery, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Korea
| | - Jin-Deok Joo
- Department of Neurosurgery, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Korea
| | - Ji Soon Huh
- Department of Neurosurgery, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Korea
| | - Ki-Bum Sim
- Department of Neurosurgery, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Korea
| | - You-Nam Chung
- Department of Neurosurgery, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Korea
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Tetsuhara K, Kaku N, Arimura K, Sakai Y, Ohga S. Quantitative indices for an intracranial aneurysm and subarachnoid hemorrhage in early childhood: a case report. BMC Neurol 2022; 22:488. [PMID: 36536327 PMCID: PMC9761937 DOI: 10.1186/s12883-022-03022-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Intracranial aneurysms (ICA) rarely occur in children under 3 years of age. Little is known for neuroimaging parameters that predict survival and clinical outcomes of patients with ICA in early childhood. CASE PRESENTATION A 2-year-old girl showed intracranial hemorrhage due to a rupture of aneurysm at the middle cerebral artery. Quantitative measurements of ischemic damages on the head computed tomography (CT) marked an extremely low score of 2 points with modified Alberta Stroke Program Early CT Score (mASPECTS). She died 15 days after admission. In publications from 2021 to 2022, we found 21 children who were under 3 years of age at onset of ICA. None of them died, but two of three patients who had mASPECTS scores 0-8 showed developmental delay and/or epilepsy as neurological complications. CONCLUSION Early CT findings are applicable for predicting survival and neurological outcomes of young children with intracranial hemorrhage.
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Affiliation(s)
- Kenichi Tetsuhara
- grid.177174.30000 0001 2242 4849Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan ,grid.411248.a0000 0004 0404 8415Emergency and Critical Care Center, Kyushu University Hospital, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan ,grid.410810.c0000 0004 1764 8161Present address: Department of Critical Care Medicine, Fukuoka Children’s Hospital, 5-1-1, Kashii-Teriha, Higashi-ku, Fukuoka, 813-0017 Japan
| | - Noriyuki Kaku
- grid.177174.30000 0001 2242 4849Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan ,grid.411248.a0000 0004 0404 8415Emergency and Critical Care Center, Kyushu University Hospital, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan
| | - Koichi Arimura
- grid.177174.30000 0001 2242 4849Department of Neurosurgery, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan
| | - Yasunari Sakai
- grid.177174.30000 0001 2242 4849Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan
| | - Shouichi Ohga
- grid.177174.30000 0001 2242 4849Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan
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Moschetti G, Vasco C, Clemente F, Galeota E, Carbonara M, Pluderi M, Locatelli M, Stocchetti N, Abrignani S, Zanier ER, Ortolano F, Zoerle T, Geginat J. Deep Phenotyping of T-Cells Derived From the Aneurysm Wall in a Pediatric Case of Subarachnoid Hemorrhage. Front Immunol 2022; 13:866558. [PMID: 35711453 PMCID: PMC9197186 DOI: 10.3389/fimmu.2022.866558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/28/2022] [Indexed: 11/13/2022] Open
Abstract
Intracranial aneurysms (IAs) are very rare in children, and the characteristics of the T-cells in the IA wall are largely unknown. A comatose 7-years-old child was admitted to our center because of a subarachnoid hemorrhage due to a ruptured giant aneurysm of the right middle cerebral artery. Two days after the aneurysm clipping the patient was fully awake with left hemiparesis. T-cells from the IA wall and from peripheral blood of this patient were analyzed by multi-dimensional flow cytometry. Unbiased analysis, based on the use of FlowSOM clustering and dimensionality reduction technique UMAP, indicated that there was virtually no overlap between circulating and tissue-infiltrating T-cells. Thus, naïve T-cells and canonical memory T-cells were largely restricted to peripheral blood, while CD4-CD8-T-cells were strongly enriched in the IA wall. The unique CD4+, CD8+ and CD4-CD8-T-cell clusters from the IA wall expressed high levels of CCR5, Granzyme B and CD69, displaying thus characteristics of cytotoxic and tissue-resident effector cells. Low Ki67 expression indicated that they were nevertheless in a resting state. Among regulatory T-cell subsets, Eomes+Tr1-like cells were strongly enriched in the IA wall. Finally, analysis of cytokine producing capacities unveiled that the IA wall contained poly-functional T-cells, which expressed predominantly IFN-γ, TNF and IL-2. CD4+T-cells co-expressed also CD40L, and produced some IL-17, GM-CSF and IL-10. This report provides to our knowledge the first detailed characterization of the human T-cell compartment in the IA wall.
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Affiliation(s)
| | - Chiara Vasco
- National Institute for Molecular Genetics (INGM), Milan, Italy
| | | | - Eugenia Galeota
- National Institute for Molecular Genetics (INGM), Milan, Italy
| | - Marco Carbonara
- Neuroscience Intensive Care Unit, Department of Anesthesia and Critical Care, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mauro Pluderi
- Department of Neurosurgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Locatelli
- Department of Neurosurgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Nino Stocchetti
- Neuroscience Intensive Care Unit, Department of Anesthesia and Critical Care, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Sergio Abrignani
- National Institute for Molecular Genetics (INGM), Milan, Italy.,Department of Clinical Sciences and Community Health University Milan, Milan, Italy
| | - Elisa R Zanier
- Laboratory of Acute Brain Injury and Therapeutic Strategies, Department of Neuroscience, Mario Negri Institute for Pharmacological Research IRCCS, Milan, Italy
| | - Fabrizio Ortolano
- Neuroscience Intensive Care Unit, Department of Anesthesia and Critical Care, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Tommaso Zoerle
- Neuroscience Intensive Care Unit, Department of Anesthesia and Critical Care, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Jens Geginat
- National Institute for Molecular Genetics (INGM), Milan, Italy.,Department of Clinical Sciences and Community Health University Milan, Milan, Italy
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