儿童缺血性脑卒中42例病因影像学特征及预后临床回顾分析

Arterial ischemic stroke in 42 children:a retrospective study of etiology,radiologic features and prognosis.

目的回顾性分析儿童缺血性脑卒中病因、梗塞血管和部位分布特征以及不同因素对患儿神经功能缺损预后的影响。方法采用回顾性病历调查方法,检索武汉市儿童医院神经内科病例数据库中2007年1月至2012年6月收治的42例患儿临床资料并进行分析;采用电话、来访等方式随访,改良兰金量表(mRS)评分为结局指标,应用多元线性逐步回归分析方法分析功能预后的影响因素。结果脑卒中发病年龄差异有统计学意义(P<0.05),其中≤3岁28例(66.7%),>3岁14例(33.3%),发病高峰见于年龄较小婴幼儿。患儿主要临床征象为肢体活动受限,其次为惊厥和意识障碍。不同年龄首发临床表现有区别,≤3岁患儿主要以惊厥和意识障碍起病,而>3岁则主要表现为偏瘫、失语和共济失调等起病。病因中以感染(38.1%,16/42)最常见,第2位为营养性缺铁性贫血(16.7%,7/42),第3位为烟雾病(11.9%,5/42)。儿童缺血性脑卒中梗塞血管和部位主要见于基底节和右侧大脑中动脉。对儿童缺血性脑卒中预后因素影响从大到小依次是:梗塞动脉分布、病因、就诊时间、年龄。结论儿童缺血性脑卒中病因复杂,在某些诱因(感染、创伤等)存在时更容易发病;儿童脑卒中影响功能预后的因素主要与梗塞动脉分布、病因、就诊时间、年龄有关。

Objective To inverstigate etiology, radiologic features and prognosis of pediatric arterial ischemic stroke. Methods The medical records of 42 pediatric patients with arterial ischemic stroke were retrospectively reviewed.Infarction location was first determined by cranioeerebral computed tomography and magnetic resonance imaging.The stenotic or occluded main cerebral arteries and/or branches were determined by angiography.All subjects were administered the Modified Rankin Scale to value the outcomes. Results The majority of the 42 cases （66.7%, n=28） were ≤ 3 years-old （vs. 〉 3 years-old： 33.3%, n= 14;P 〈 0.05 ） and the initial clinical manifestation was different among the different age groups.For all subjects, the most frequent etiologies were infections （ 38.1%, n= 16 ）, iron deficiency anemia （ 16.7%, n=7 ）, and moyamoya syndrome （ 11.9%, n=5）.The predominant infarcts among all cases were middle cerebral artery and basal ganglia.Among all the clinical parameters, the major risk factors affecting prognosis of pediatric arterial ischemic stroke included age, visiting time, distributions of infarction aeries and etiologies. Conclusion Pediatric arterial ischemic stroke occurs more frequently in younger children and this group most frequently presents with convulsion as the initial symptom.For pediatric stroke, the overall etiologies may be different from those of adult stroke.