枕区脑损伤影像学与临床转归特点分析

The image and clinical outcome of brain structure damage in occipital lobe

目的探讨影像学提示脑枕区结构损伤患儿的智能发育轨迹特点。方法收集头颅影像学提示枕区结构损伤患儿17例,按枕区损伤部位分类,采用临床随访,对癫表现、脑电图表现、药效及生长发育等方面进行监测评价。结果围生期低血糖为枕区脑损伤常见病因(58.8%～70.6%);单纯枕区脑白质损伤3例,皮层及皮层下白质为主性损伤14例。17例患儿中,合并眼部异常表现16例,表现形式多样,表现随时间而变化;合并癫发作14例,占82.4%,其中婴儿痉挛11例,均为枕区皮层及皮层下白质损伤为主者,脑电图提示不对称性部分起源的高度失律,促肾上腺皮质激素治疗有效者8例;出现全身异常抖动者14例,占82.4%,单纯枕区脑白质损伤患儿均出现抖动发作;丹佛发育筛查试验测评,运动发育落后15例,癫控制后,运动能力明显进步8例,其中2例因合并先天性胼胝体发育不良,肌张力高,运动严重落后。结论围生期低血糖常导致枕区脑损伤;枕区脑损伤常伴随眼部异常表现及导致婴儿期全身异常抖动发作,后者多为癫发作前表现;婴儿痉挛为枕区皮层损伤常见并发症,癫控制为智能发育进步的先决条件。

Objective To explore the impact of brain structure damage in occipital lobe on developmental aspects in children.Methods The imaging of brain structure damage in occipital lobe of 17 cases was analyzed.Evaluation was on classification of epilepsy,performance,and EEG monitoring,efficacy analysis,growth monitoring by comparing the different areas of injury with clinical follow-up.Results Perinatal hypoglycemia is the common cause（73.8%-58.8%）for occipital lobe brain structure damage;3 cases had simple brain white matter injury,fourteen cases had cortical and subcortical white matter damage;Sixteen of the total 17 cases had eye abnormal manifestation with various forms and change over time.Fourteen cases（82.4%）had epilepsy,baby spasms developed in 11 cases（64.7%）,with EEG performance of asymmetry part origin and height disorders.Treatment with ACTH was effective in 8 cases.Fourteen cases（82.4%）had abnormal jitter attack,and all of them showed pure white matter damage in imaging.Five cases had motor development retardation by DDST assessment.The sport ability markedly improved in 8 cases after epilepsy had been controlled.Two cases had high muscle tension and serious backward sports development with congenital corpus callosum demonstrated stunted growth in imaging.Conclusions Perinatal hypoglycemia is a common cause of occipital lobe brain structure damage,which often results in abnormal ocular performance and infancy systemic jitter attack,usually as pre-epilepsy signs.Baby spasm is a frequent complication.Control of epilepsy is important to developmental improvement.