Intracerebral Vascular Disorders

Subarachnoid hemorrhage may occur following trauma or spontaneous rupture of a berry aneurysm or arteriovenous malformation. Nuchal rigidity is an inconstant finding. Venous thrombosis may follow severe dehydration or a pyogenic infection of the paranasal sinuses, mastoid, or middle ear. Periorbital edema with cranial nerve abnormalities is a clue. Arterial thrombosis is uncommon in children, except in those with homocystinuria. Children with homocystinuria have a marfanoid appearance, dislocated lenses, and mental retardation. Intracerebral and intraventricular hemorrhages may follow birth asphyxia or trauma in neonates, but in older children they may signify a congenital or acquired coagulopathy. Signs of subacute bacterial endocarditis include splinter hemorrhages, splenomegaly, microscopic hematuria, and AMS caused by cerebral emboli. Acute infantile hemiplegia presents with an acute seizure followed by hemiparesis and coma. Acute confusional migraine may be associated with profound alterations in consciousness.

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