儿童缺血性脑卒中的临床特点及病因分析  

Clinical Characteristics and Etiology Analysis of Children with Ischemic Stroke

作　　者：刘平[1,2] 张月华[1] 马秀伟[1] 熊晖[1] 包新华[1] 姜玉武[1] 邹丽萍[3] 秦炯[1] 吴希如[1] 

机构地区：[1]北京大学第一医院儿科,北京100034 [2]成都市儿童医院神经内科,成都610017 [3]首都医科大学附属北京儿童医院神经内科,北京100045

出　　处：《实用儿科临床杂志》2008年第24期1891-1893,共3页Journal of Applied Clinical Pediatrics

基　　金：首都医学发展科研基金项目资助(2005-1012)

摘　　要：目的总结儿童缺血性脑卒中(IS)的临床特点及病因。方法对1997年9月-2008年7月在北京大学第一医院儿科住院的65例IS患儿病例资料进行回顾性分析。男42例,女23例;发病年龄3个月～15岁,平均5.2岁。结果常见的神经系统表现依次为肢体偏瘫[58例(89.2%)],中枢性面瘫[36例(55.4%)],惊厥[19例(29.2%)],语言障碍[17例(26.2%)],头痛[12例(18.5%)],感觉障碍[10例(15.4%)],锥体外系症状[5例(7.7%)]。神经影像学(CT/MRI)检查显示梗死灶位于基底核区32例(49.2%),其中27例仅有基底核区梗死,5例同时伴其他部位梗死。多脑叶梗死26例(40.0%),顶叶梗死4例(6.2%),半球梗死3例(4.6%),颞叶梗死、丘脑梗死各2例(各3.1%),脑干梗死1例(1.5%)。65例患儿中,40例进行了血管影像学检查,其中31例异常,以大脑中动脉受累最常见(26例,83.9%)。常见病因为烟雾病(18例,27.7%),头部外伤(16例,24.6%)和感染(14例,21.5%),17例(26.2%)患儿为多病因共存,13例(20.0%)患儿未找到任何病因。结论儿童IS发病高峰为幼儿及学龄前期;最常见的神经功能障碍为肢体瘫痪;神经影像学显示基底核区梗死最常见;常见病因为烟雾病、外伤和感染。Objective To summarize the clinical characteristics and etiology of ch;ldren with ischemic stroke （IS）. Methods The clinical data of 65 children with IS who were hospitalized in Peking University First Hospital from Sep. 1997 to Jul. 2008 were analyzed retrospectively. There were 42 boys and 23 girls. The median onset age of stroke was 5.2 years （ ranged from 3 months to 15 years old）. Results The common clinical manifestations included hemiplegia in 58 cases （ 89.2% ）, central facial paralysis in 36 cases （55.4%）, seizures in 19 cases （29.2%） , speech impairment in 17 cases （26.2%）, headache in 12 cases （18.5 % ）, sensory impairment in 10 cases （15.4%）, and extrapyramidal symptoms in 5 cases （7.7%）. Neuronal imaging showed the regions of infarction in basal ganglia in 32 cases （49.2%）. Among 32 cases, 27 cases had only basal ganglia infarction,5 cases had basal ganglia and other location infarction. Several lobes in 26 cases （40.0%）, parietal lobe in 4 cases （6.2%）, hemisphere in 3 cases （4.6%）, temporal lobe in 2 cases （3.1%）, thalamus in 2 cases （3.1%）, and brain stem in l case （ 1.5% ）. Forty cases were carried out blood vessel imageology examination ,31 cases showed abnormality, the most common affected cerebral blood vessel were middle cerebral artery （26 cases ,83.9% ）, the common causes of IS were moyamoya disease （18 cases,27.7% ）, trauma （16 cases,24.6% ） and infection （14 cases,21.5% ）. Seventeen children （26.2%） had more than one risk factors, 13 children （20.0%） had no identifiable cause. Conclusions The peak onset of IS in children is in infancy and pre - school children. The most frequent neurological deficit is hemiplegia. The most conanon region of infarction is in basal ganglia. The common causes of IS were moyamoya disease, tramna and infection.

关 键 词：缺血性卒中 病因 儿童 

分 类 号：R743.3[医药卫生—神经病学与精神病学]