{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T18:11:37Z","timestamp":1791569497263,"version":"4.3.4"},"reference-count":33,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2023,3,3]],"date-time":"2023-03-03T00:00:00Z","timestamp":1677801600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Euro J of Neurology"],"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and purpose<\/jats:title><jats:p>We aimed to assess the course and predictors of functional outcome after single and multiple intracerebral hemorrhage (ICH) in pediatric patients with cerebral cavernous malformations (CCMs) and to conduct a risk assessment of a third bleed during the first follow\u2010up year after second ICH.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We included patients aged \u226418\u2009years with complete baseline characteristics, a magnetic resonance imaging dataset, \u22651 CCM\u2010related ICH and\u2009\u22651 follow\u2010up examination, who were treated between 2003 and 2021. Neurological functional status was obtained using modified Rankin Scale scores at diagnosis, before and after each ICH, and at last follow\u2010up. Kaplan\u2013Meier analysis was performed to determine the cumulative 1\u2010year risk of third ICH.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 55 pediatric patients (median [interquartile range] age 12\u00a0[11] years) were analyzed. Univariate analysis identified brainstem cavernous malformation (BSCM; <jats:italic>p<\/jats:italic>\u00a0=\u20090.019) as a statistically significant predictor for unfavorable outcome after second ICH. Outcome after second ICH was significantly worse in 12 patients (42.9%; <jats:italic>p<\/jats:italic>\u00a0=\u20090.030) than after first ICH and in five patients (55.6%; <jats:italic>p<\/jats:italic>\u00a0=\u20090.038) after a third ICH compared to a second ICH. Cumulative 12\u2010month risk of rebleeding during the first year after a second ICH was 10.7% (95% confidence interval 2.8%\u201329.37%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Pediatric patients with a BSCM have a higher risk of worse outcome after second ICH. Functional outcome improves over time after an ICH but worsens following each ICH compared to baseline or previous ICH. Second bleed was associated with neurological deterioration compared to initial ICH, and this deteriorated further after a third ICH.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ene.15749","type":"journal-article","created":{"date-parts":[[2023,2,15]],"date-time":"2023-02-15T07:35:49Z","timestamp":1676446549000},"page":"1364-1370","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Functional outcome after initial and multiple intracerebral hemorrhages in children with cerebral cavernous malformations"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6616-5313","authenticated-orcid":false,"given":"Alejandro N.","family":"Santos","sequence":"first","affiliation":[{"name":"Department of Neurosurgery and Spine Surgery University Hospital Essen  Essen Germany"},{"name":"Center for Translational Neuroscience and Behavioral Science (C\u2010TNBS) University of Duisburg\u2010Essen  Essen 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