儿童大面积脑梗死一例报告

A Case Report of Extensive Cerebral Infarction in Children

目的提高对儿童脑梗死的认识,以降低致死、致残率。方法回顾分析1例儿童大面积脑梗死的临床资料。结果患儿因右侧肢体无力9个月余,抽搐1次收入院。曾于外院行颅脑磁共振动脉造影(MRA)检查示右侧额叶后部、颞顶叶、岛叶及左侧基底核区脑梗死。入我院4 h后患儿意识进行性恶化至深昏迷,双侧瞳孔不等大,对光反射消失。急诊行颅脑MR检查示右侧大脑中动脉供血区急性脑梗死;左侧基底核区陈旧性脑梗死;脑疝形成。家属放弃治疗,患儿出院。于离院后4 h死亡。结论儿童脑梗死的常见病因有感染、外伤、血管畸形、全身性疾病及动脉发育不良等,治疗原则同成人,对明确病因的患儿应同时加强病因治疗。

Objective To raise the awareness of cerebral infarction in clildren to induce mortality and morbidity rates. Methods Retrospective analysis of the clinical date of one case of extensive cerebral infarction in children was conducted.Results The child was admitted to the hospital with the right limb weakness for 9 months,and with onset of seizure attack.The brain magnetic resonance angiography（MRA） examination in the previous hospital revealed that the back of the right frontal lobe,temporal lobe,insula and left basal ganglia had infarction.Four hours after admission,the awareness of child progressively deteriorated into deep coma,bilateral pupils appeared in differents sizes,and light reflex disappeared.Emergency MR imaging of brain showed that the right middle cerebral artery territory had acute cerebral infarction and herniation,and the left basal ganglia area had chronic infarction.The parents of the child abandoned treatment and the child died 4 h after discharge.Conclusion The common causes of cerebral infarction in children are infection,trauma,vascular malformations,systemic disease and arterial dysphasia.The treatment principles are no different from that of adults,but for children with specific causes,the pathogeny cure should be strengthened.