儿童缺血性卒中的危险因素及临床特点分析

Analysis of Risk Factors and Clinical Characteristics of Ischemic Stroke in Children

目的回顾性分析儿童缺血性卒中的危险因素、临床特点、影像学特点及治疗现况。方法对2002年1月至2011年6月在北京天坛医院儿科及神经内科就诊的81例缺血性卒中儿童的病历资料进行回顾性分析。结果 81例患者中,男60例,女21例。发病年龄7个月～1 8岁,平均年龄(6.99±5.60)岁,7个月～3岁(婴幼儿期)为发病高峰,为34例(41.9%)。病因中头部外伤(走路时摔倒或坠床)30例(37 04%)、感染13例(16.05%)、高同型半胱氨酸血症8例(9.88%)、血管炎6例(7.4%)、心脏病5例(6.17%)、动脉夹层5例(6.17%)、烟雾病4例(4.94%)、动脉瘤1例(1.23%)、神经纤维瘤病Ⅰ型1例(1.23%),23例(28.4%)未找到明确病因。卒中发作时75例表现为肢体瘫痪(偏瘫69例、四肢瘫4例、交替瘫2例),占92.6%;其次为中枢性面瘫46例(56.8%);其他表现为感觉减退或麻木、头痛、癫痫等。神经影像学显示梗死部位位于基底节区60例(74.1%)、脑叶6例(7.4%),小脑4例(5%)、多发病灶(基底节、脑叶及内囊)11例(13.5%)。结论婴幼儿期是儿童缺血性卒中发病高峰。肢体瘫痪为最常见的临床表现。本研究头部外伤和感染是儿童卒中的主要病因。儿童卒中前循环受累较后循环多见,其中大脑中动脉供血区缺血梗死最常见。

Objective To summarize the risk factors, etiology and clinical features ofisehemic stroke in children. Methods The clinical data of 81 children with ischemic stroke who were hospitalized in Beijing Tiantan Hospital Affiliated to the Capital Medical University from Jan. 2002 to Jun. 2011 were analyzed retrospectively. Eighty-one children were enrolled. Results There were 60 boys and 21 girls, median onset age of stroke was 6.99 years（ranged from 7 months to 18 years old）. Risk factors and etiology included head trauma（37.04%）, infection（16.05%）, hyperhomocysteinemia（9.88%）, vasculitis（7.4%）, cardiac disease（6.17%）, dissection（6.17%）, moyamoya disease（4.94%）, aneurysm（1.23%） and neurofibromatosis type i（1.23%）. 28.4 percent（n=23） had no identifiable cause. The most frequent clinical manifestation was hemiplegia（92.6%）. Central facial paralysis was found in 46 cases. Other neurological manifestation included abnormal feeling, headache and epilepsy. Basal ganglia infarction was found in sixty cases（74.1%） and infarction on the left side was more common than on the right. Conelusion The peak onset of arterial ischemic stroke（AIS） in children is in infancy. Hemiplegia is the most common neurological manifestation. Basal ganglia is the most common territory of infarction. Anterior circulation is more easily involved than posterior circulation.