不同年龄组儿童急性偏瘫伴随症状与病因的关系

Age,Concomitant Symptoms and the Etiology of Acute Hemiplegia in Childhood

目的探讨儿童不同年龄组急性偏瘫伴随症状和病因的关系。方法对2007 2009年本院收治的31例急性偏瘫患儿的临床资料进行回顾性分析。结果 31例患儿中,<1岁5例,>1～3岁12例,>3～6岁儿童4例,>6岁年长儿10例。主要伴随症状:惊厥21例、发热12例、意识障碍10例。急性偏瘫的主要病因:①脑血管病10例:其中脑血管畸形4例(幼儿3例、学龄儿1例)、外伤性脑梗死2例(学龄前)、合并先天性代谢缺陷病(同型半胱氨酸血症)2例;②中枢神经系统感染9例(<1岁4例);③先天代谢性缺陷病5例(均为年长儿);④偏侧惊厥偏瘫综合征/偏侧惊厥偏瘫癫痫综合征(hemiconvulsion-hemiplegia/hemiconvulsion-hemiplegia-epilepsy syndrome,HH/HHE)4例;交替性偏瘫2例;⑤其他:维生素K_1缺乏性颅内出血、急性播散性脑脊髓炎和脑干肿瘤各1例。结论①小儿急性偏瘫病因繁多,各年龄段均有发病,其中1～3岁所占比例最大;②偏瘫主要伴随症状有惊厥、发热、意识障碍;伴随症状不同其病因各异;③婴幼儿主要病因是中枢神经系统感染,幼儿和学龄前期儿童中外伤性脑梗死和脑血管畸形并不少见;先天性代谢缺陷病是年长儿偏瘫的病因之一。

Objective To investgate the etiology of acute hemiplegia in childhood. Methods We did the retrospective research of the concomitant symptoms of 31 in hospital children with acute hemiplegia from Jan. 2007 to Dec. 2009 to find the relation between the cause and the symptoms. Among these patients, there were 5 infants, 12 toddlers, 4 children between 3 to 5 years, 10 children between 10 to 16 years old. Results The etiology varied, 9 patients suffered from central nervous system infections, 4 of them were babies; 4 brain vascular malformations, 3 toddlers; 2 patients had acute brain infarct after minor head injury; 5 inborn metabolic diseases and all were older than l0 years old; 4 hemiconvulsion-hemiplegia/hemiconvulsion-hemiplegia-epilepsy syndrome（HH/HHE）; 2 alternating hemiplegia of childhood. Conclusions Lots of diseases can cause acute hemiplegia of childhood, in infants and toddlers, brain infections were the most common cause, and were less common in older children. Acute brain infarcts and brain vascular malfunction were not uncommon in toddler and preschool child with acute hemiplegia. Inborn metabolic errors were causes of acute hemiplegia in elder children.