临床表现有惊厥的新生儿脑梗死16例分析

Analysis of cere bral infarction in 16 newborn infants with seizures

目的探讨新生儿脑梗死的可能病因、临床特点及预后。方法回顾性分析2011-06~2015-06我院新生儿内科临床表现有惊厥的16例新生儿脑梗死患儿的临床资料,分析其发病原因、临床表现、影像学特点及部分患儿随访结果。结果表现有惊厥的16例脑梗死患儿均为足月儿,母亲第1产13例(81%),有宫内窘迫史9例(56%);惊厥发作形式为多灶性阵挛型10例(62.5%),生后惊厥出现平均时间为(56.18±90.69)h;头颅MRI检查,脑梗死累及左侧大脑半球12例(75%);随访10例患儿中,有3例预后不良,预后不良患儿头颅MRI脑梗死累及额、顶、枕叶、内囊、基底节、胼胝体及丘脑中3个或3个以上部位。结论各种原因导致的围生期缺氧可能在新生儿脑梗死的发病机制中扮有重要作用;惊厥是常见的临床表现,多灶性阵挛型为其主要发作形式,头颅MRI左侧大脑半球脑梗死较常见,脑梗死多部位受累者预后较差。

Objective To explore the possible etiology,clinical characteristics and prognosis of neonatal cerebral infarction. Methods Sixteen cerebral infarction neonates with seizures were retrospectively analyzed in our neonatal department from June 2011 to June2015,including the etiology,clinical manifestations and imaging features and the follow-up data of some infants. Results Sixteen newborn infants with cerebral infarction were full term,13 cases（81%） were G1P1,and 9（56%） had fetal distress. The seizure episodes in 10 cases（62. 5%） of neonates were multifocal clonic seizure,and the average onset time of postpartum seizures was（56. 18 ±90. 69） h. MRI results of 16 cases showed that 12 cases of cerebral infarct involved in the left side of the brain hemisphere. During the follow-up,three out of 10 cases had poor prognosis with brain infarction involving in three or more than three parts in frontal,top,occipital lobe,internal capsule,basal ganglia,callosum,thalamus in their cranial MRI. Conclusion Perinatal hypoxia may play an important role in the pathogenesis of neonatal cerebral infarction. Seizure is a common clinical manifestation,and the multifocal clonic seizure is the main form. Left cerebral hemisphere infarction is the common imaging findings of cranial MRI. Those patients with multifocal involvement of cerebral infarction could have poor prognosis.