儿童动脉缺血性卒中的病因

Etiologies Analysis of Pediatric Arterial Ischemic Stroke

目的总结儿童动脉缺血性卒中(AIS)的临床特点、病因及危险因素。方法回顾性分析2003年1月-2011年3月在重庆医科大学附属儿童医院住院治疗的AIS患儿资料,采用SPSS 17.0软件进行分析,描述患儿年龄、性别分布等基本情况、相关病因及危险因素,并分析头部轻微外伤与基底核钙化是否存在相关性。结果本组患儿中,男31例,女27例;年龄2个月～13岁,平均3岁10个月。常见神经系统表现依次为肢体偏瘫52例(92.8%),中枢性面瘫34例(58.6%),运动性失语16例(27.6%),头痛、呕吐11例(19.0%),意识障碍8例(13.8%),惊厥7例(12.1%)。40例进行血管影像学检查,其中33例异常,左侧大脑中动脉受累最常见(19例,47.5%)。常见病因为轻微头部外伤(26例,44.8%)、烟雾病(8例,13.8%)和颅内感染(5例,8.6%),18例(31.0%)患儿为多病因共存,6例(10.3%)患儿未找到任何病因或危险因素,22例(37.9%)患儿有呼吸道感染。结论儿童AIS发病高峰人群为幼儿及学龄前期儿童,最常见的神经功能障碍为肢体偏瘫,神经影像学显示左侧大脑中动脉狭窄或中断最常见,常见病因为轻微头部外伤、烟雾病及颅内感染,较多患儿病前或病程中有上呼吸道感染。积极预防感染、减少头部外伤,对突发偏瘫患儿早期行头颅影像和血管检查将有利于AIS的预防和早期诊断。

Objective To study the characteristics of pediatric arterial ischemic stroke （ AIS）, and to exam the etiology and risk factor. Methods This study retrospectively reviewed the records of all patients in Children＇s Hospital of Cbongqing Medical University from Jan. 2003 to Mar. 2011, and patients were eligible for analysis if they had been diagnosed with AIS. The characters, etiologies and risk factors were described and the relation between trivial head injury and basilar ganglia calcification were analyzed through SPSS 17.0 software. Results Thirty -one boys and 27 girls were enrolled in the study, with age of 2 months to 13 years （average：3 years and 10 months）. And Major clinical neurological manifestations were paralysis （n =52, 92.8% ）, central facial palsy （n =34, 58.6% ）, motor aphasia （n = 16, 27. 6% ）, vomiting and headache （ n = 1 l, 19.0% ）, loss of consciousness （ n = 8, 13.8% ）, and convulsion （ n = 7, 12.1% ）. In reviewed 58 cases, 40 cases had radical vascular exams, in which 33 cases showed abnormalities, and left middle cerebral artery was the most commonly involved among basal cerebral arteries（ n = 19,47.5% ）, Major risk factors were trivial head injury （ n = 26, 44.8% ）, moyamoya disease （ n = 8, 13.8% ） and intracranial infection （n = 5, 8.6% ）. Eighteen cases had more than one risk factor （31.0% ）, 6 cases （10.3%） had no defined risk factor or etiologies. Additionally, 22 cases （37.9%） had respiratory infection. Conclusions The peak morbidity period is during toddler and before school period, and common neur61ogical presentation is paralysis. Stenosis or occlusion of left middle cerebral artery is ma- jor radical image, and the main risk factors are trivial head injury, moyamoya disease and intracranial infection. Prevention of infectious disease, induction of head injury are effective to prevention of AIS, and image examination of head and intracranial vascular as soon as possible is beneficial to early diagnosis.