新生儿卒中的临床特点与诊治探讨

Clinical characteristics and diagnosis and treatment of neonatal stroke

目的了解新生儿卒中(neonatal stroke,NS)的临床特点,提高对NS的认识,减少漏诊或误诊。方法对37例NS的临床资料进行回顾性调查分析,记录各种围生期因素、临床表现和影像学检查结果。结果 1)37例患儿中31例(83.8%)有神经系统症状体征,其中24例(77.4%)以惊厥为首发症状或主要表现,15例(62.5%)有定位意义。10例(32.3%)原始反射减弱。6例(16.2%)患儿无明显神经系统异常表现,而在头颅影像学检查时发现脑梗死改变;2)发病时间最短生后10min,最长12d。其中在生后24h内发病者23例(74.2%),48h内发病者27例(87.1%),72h内发病28例(90.3%);3)剖宫产分娩26例(70.3%),自然分娩11例(29.7%);4)围生期缺氧史16例(43.2%),胎膜早破和宫内感染10例(27.0%);5)双侧大脑半球同时受累18例(48.6%),左侧大脑半球受累12例(32.4%),右侧大脑半球与基底节受累各7例(18.9%)。结论惊厥是NS最常见临床表现,且常为首发症状;发病早;剖宫产分娩者占70%以上;围生期缺氧、宫内感染与新生儿NS密切相关,为其重要高危因素;常为双侧大脑半球同时受累,单侧大脑半球梗死左侧多于右侧,近20%的患儿同时合并有基底节梗死;60%以上患儿预后不良;确诊有赖于影像学检查,首选颅脑B超,进一步确诊可作MRI-DWI。

Objective To explore the clinical characteristics of neonatal stroke （NS） and provide some theoretical references for its diagnosis and treatment. Methods The clinical data of 37 cases of NS retrospectively were analyzed,including various perinatal factors, clinical manifestations and neuroimaging findings. Results 1） In 37 cases, 31 cases （83.8 % ） presented with significant nervous system symptoms and signs, including 24 patients （77.4%） started with convulsion or being as the main clinical manifestation,15 patients （62.5%） had the significance of fixed position. 10 cases （32.3%） were with weakening primary reflexes. But 6 patients （16.2 % ） did not present with any obvious neurological abnormal manifestations,cerebral infarction changes could be found only by head imaging examinations. 2）The earliest onset time was 10 minutes after birth,while the latest was 12 days after birth. 23 cases of the 31 patinets（74.2%） were attacked by NS within 24 hours after birth,27 cases（87.1%）within 48 hours and 28 cases（90.3%）within 72 hours. 3）26 patients（70.3%） were given by cesarean delivery,11 patients（29.7%） were given by natural childbirth. 4）16 patients（43.2%）were with the history of perinatal hypoxia and 10 patients（27.0%） were with premature rupture of membranes （PROM） or intrauterine infection. 5） 18 patients （48.6%） were injured in bilateral hemisphere,12 cases （32.4%） in left hemisphere,7 cases （18.9%） in right hemisphere and 7 cases （18.49） in the basal ganglia. Conclusions 1）Convulsion is the most common clinical manifestation of NS. 2）Early onset. 3）Cesarean section is closely correlated with NS, accounting for more than 70 %. 4）Perinatal hypoxia , PROM and intrauterine infection are the most common reasons of NS. 5）Bilateral hemisphere simultaneously involved infarction is the commonest, accounting for nearly 50 %. In unilateral hemispheric infarction, the left side suffered more than the right side,basal ganglia infarction simultaneously existed in nearly 20% of NS patients. 6）More than 60% of the patients were with poor prognosis. 7）The diagnosis of NS depends on the imaging examinations,head B ultrasound is a prior choice, but further diagnosis depends on MRI-DWI.