Aneurysms in children account for <1% of SAH due to aneurysms in all age groups [62]. The mortality in pediatric aneurysm has been reported to be 1.3%, with morbidity including infarction (8%) and seizures (4%) [63]. Only 0.6% of ruptured aneurysms occur in patients <19 years of age [51,60]. Aneurysms in children are idiopathic (45%), post-traumatic (20%), or due to a variety of conditions causing abnormal vessel-wall hemodynamic stress [62]. In contrast to adults, aneurysms in children are more likely to be giant (>25 mm) or fusiform [62]. Children with a positive family history of aneurysm account for <5% of pediatric aneurysms, and fewer than 2% of patients with a positive family history of aneurysm develop an aneurysm in the first two decades of life [62]. Fusiform aneurysms are more likely to increase in size over time than are saccular aneurysms [64]. CT Head The initial imaging study in suspected SAH is a noncontrast head CT. If the CT is negative for SAH, lumbar puncture may be performed. Unenhanced head CT is useful in ruptured aneurysms to assess the location and size of hemorrhage, evidence of mass effect, and hydrocephalus [59]. Small aneurysms are difficult to evaluate with unenhanced CT whereas a giant aneurysm, if present, appears as a hyperdense mass. CTA Head CTA is a noninvasive alternative to catheter angiography to show an underlying vascular cause of SAH with reported sensitivity (96.5%) and specificity (88%) for aneurysms of all sizes with sensitivity (98.4%) and specificity (100%) for aneurysms >3 mm [65]. CTA is used to confirm the presence of aneurysm and may be used as an adjunct to catheter angiography in the pretreatment assessment of aneurysm. CTA provides an alternative to catheter angiography for assessing residual or recurrent aneurysm but may be limited by streak artifact from the treatment device.
Cerebrovascular Disease Child PCAs. Aneurysms in children account for <1% of SAH due to aneurysms in all age groups [62]. The mortality in pediatric aneurysm has been reported to be 1.3%, with morbidity including infarction (8%) and seizures (4%) [63]. Only 0.6% of ruptured aneurysms occur in patients <19 years of age [51,60]. Aneurysms in children are idiopathic (45%), post-traumatic (20%), or due to a variety of conditions causing abnormal vessel-wall hemodynamic stress [62]. In contrast to adults, aneurysms in children are more likely to be giant (>25 mm) or fusiform [62]. Children with a positive family history of aneurysm account for <5% of pediatric aneurysms, and fewer than 2% of patients with a positive family history of aneurysm develop an aneurysm in the first two decades of life [62]. Fusiform aneurysms are more likely to increase in size over time than are saccular aneurysms [64]. CT Head The initial imaging study in suspected SAH is a noncontrast head CT. If the CT is negative for SAH, lumbar puncture may be performed. Unenhanced head CT is useful in ruptured aneurysms to assess the location and size of hemorrhage, evidence of mass effect, and hydrocephalus [59]. Small aneurysms are difficult to evaluate with unenhanced CT whereas a giant aneurysm, if present, appears as a hyperdense mass. CTA Head CTA is a noninvasive alternative to catheter angiography to show an underlying vascular cause of SAH with reported sensitivity (96.5%) and specificity (88%) for aneurysms of all sizes with sensitivity (98.4%) and specificity (100%) for aneurysms >3 mm [65]. CTA is used to confirm the presence of aneurysm and may be used as an adjunct to catheter angiography in the pretreatment assessment of aneurysm. CTA provides an alternative to catheter angiography for assessing residual or recurrent aneurysm but may be limited by streak artifact from the treatment device.