儿童动脉性缺血性卒中

Arterial ischemic stroke in children

卒中是儿童残疾和死亡的一个重要原因，其危险因素与病理生理学过程与成年患者存在显著差异。儿童动脉性缺血性卒中（arterial ischemic stroke，AIS）的常见危险因素包括脑动脉病、心脏疾病、血液系统和代谢性疾病、感染以及遗传因素。AIS的临床表现因年龄、基础病因和卒中部位而异。在经过充分检查之后，90％以上的AIS患儿均可检出某些危险因素或促发因素，从而强调全面诊断评估的重要性。虽然已发表了一些儿童卒中方面的临床指南，但其证据基础却相当薄弱。因此，目前的治疗仍然主要基于专家共识以及从成年人卒中研究中得出的结论。文章对儿童AIS的流行病学、危险因素、临床评估、处理和转归进行综述。

Stroke is an important cause for childhood disability and death. Its risk factors and pathophysiological processes have significant differences with the adult patients. The common risk factors for pediatric arterial ischemic stroke （AIS） include cerebral arteriopathy, cardiac diseases, blood system and metabolic diseases, infection, and genetic factors. The clinical manifestations of AIS are different because of the age, underlying cause, and location of stroke. After a full examination, some risk factors or precipitating factors can be identified in more than 90% of children with AIS, and thus emphasizing the importance of comprehensive diagnosis and evaluation. Although a number of clinical guidelines for pediatric stroke have been published, its evidence base is rather weak. Therefore, the present treatment mainly bases upon the expert consensus and the conclusions from the adult stroke studies. This article reviews the epidemiology, risk factors, clinical evaluation, management and outcome of pediatric AIS.