以谵语为临床表现的儿童烟雾病合并大面积脑梗死1例及文献复习

Clinical manifestations of delirium in children with moyamoya disease with massive cerebral infarction:a case report and literature review

目的通过报道1例以谵语为临床表现的儿童烟雾病合并大面积脑梗死病例的诊断过程,提高儿科医生对儿童烟雾病的重视和对儿童烟雾病临床表现的认识程度。方法回顾性分析1例以谵语为临床表现的儿童烟雾病合并大面积脑梗死病例的临床资料与诊疗过程。结果病儿12岁,男性,以谵语为主要临床表现。头颅CT示左侧大脑半球大面积脑梗死;颅脑MRI+MRA诊断:(1)烟雾病,并右侧一向前上纵形畸形血管;(2)左侧颞顶枕叶大片异常信号灶,考虑急性缺血、缺氧并梗死改变,感染性病变不除外。确立诊断为烟雾病,脑梗死。后转至神经外科行联合血管重建术治疗,经随访病儿恢复状况良好。结论儿童烟雾病临床表现以肢体无力、感觉障碍等为常见症状,以谵语为临床表现较为少见。临床工作中应提高儿科医师对儿童烟雾病的重视程度,对不明原因谵语、精神障碍、发热、头痛、癫痫发作等表现者,在排除其他病因后,应早做影像学检查并行及时有效处理,尽快的确诊病儿。

Objective Reported by 1 case with delirious speech as the clinical manifestations of the diagnosis of moyamoya disease in children with large area cerebral infarction cases process was reported,by which to improve the pediatrician’s emphasis on moyamoya disease in children and the awareness of clinical manifestations of children moyamoya disease.Methods The clinical data and the diagnosis and treatment of a case of childhood moyamoya disease with large area cerebral infarction were retrospectively analyzed.Results The children were 12 years old,male,with delirious speech as the main clinical manifestation.Skull CT showed large cerebral infarction in the left hemisphere.Brain MRI+MRA diagnosis:1.Moyamoya disease,and on the right side of a longitudinal deformed blood vessel.2.Large abnormal signal foci of the left temporal occipital lobe,considering acute ischemia,hypoxia and infarction changes,with no exception of infectious lesions.Establish a diagnosis of moyamoya disease,cerebral infarction.The patient was transferred to neurosurgery and treated with combined vascular reconstruction.The patient recovered well after follow-up. Conclusion The clinical manifestation of childhood moyamoya disease is characterized by weakness of limbs and sensory disturbance.And delirious speech is rare.Pediatricians should be increased in clinical work emphasis of moyamoya disease in children, for unknown reasons delirious speech,mental disorders,fever,headache,seizures and other performers,after ruling out other causes, should do early imaging examination parallel to the timely and effective treatment,the diagnosis of children as soon as possible.