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JAMA Neurol. 2014 Feb;71(2):165-71. doi: 10.1001/jamaneurol.2013.4672.

Frequency of hematoma expansion after spontaneous intracerebral hemorrhage in children.

Author information

  • 1Departments of Pediatrics and Neurology, Yale University School of Medicine, New Haven, Connecticut.
  • 2Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
  • 3Division of Child Neurology, Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee.
  • 4Stanford Stroke Center, Palo Alto, California.
  • 5Division of Pediatric Neurology, Kaiser Permanente Oakland Medical Center, Oakland, California.
  • 6Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland.



Hematoma expansion is the only modifiable predictor of outcome in adult intracerebral hemorrhage; however, the frequency and clinical significance of hematoma expansion after childhood intracerebral hemorrhage are unknown.


To assess the frequency and extent of hematoma expansion in children with nontraumatic intracerebral hemorrhage.


Prospective observational cohort study at 3 tertiary care pediatric hospitals. Children (≥ 37 weeks' gestation to 18 years) with nontraumatic intracerebral hemorrhage were enrolled in a study from 2007 to 2012 focused on predictors of outcome. For this planned substudy of hematoma expansion, neonates 28 days or younger and participants with isolated intraventricular hemorrhage were excluded. Children with 2 head computed tomography (CT) scans within 48 hours were evaluated for hematoma expansion and were compared with children with only 1 head CT scan. Consent for the primary cohort was obtained from 73 of 87 eligible participants (84%); 41 of 73 children enrolled in the primary cohort met all inclusion/exclusion criteria for this substudy, in whom 22 had 2 head CT scans obtained within 48 hours that could be evaluated for hematoma expansion. Within our substudy cohort, 21 of 41 (51%) were male, 25 of 41 (61%) were white, 16 of 41 (39%) were black, and median age was 7.7 years (interquartile range, 2.0-13.4 years).


Primary outcome was prevalence of hematoma expansion.


Of 73 children, 41 (56%) met inclusion criteria, and 22 (30%) had 2 head CT scans to evaluate expansion. Among these 22 children, median time from symptom onset to first CT was 2 hours (interquartile range, 1.3-6.5 hours). Median baseline hemorrhage volume was 19.5 mL, 1.6% of brain volume. Hematoma expansion occurred in 7 of 22 (32%). Median expansion was 4 mL (interquartile range, 1-11 mL). Three children had significant (>33%) expansion; 2 required urgent hematoma evacuation. Expansion was not associated with poorer outcome. Compared with children with only 1 head CT scan within 48 hours, children with 2 head CT scans had larger baseline hemorrhage volumes (P = .05) and were more likely to receive treatment for elevated intracranial pressure (P < .001).


Hematoma expansion occurs in children with intracerebral hemorrhage and may require urgent treatment. Repeat CT should be considered in children with either large hemorrhage or increased intracranial pressure.

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