儿童局灶性脑动脉病致卒中的临床特征和预后分析

Clinical features and prognostic analysis of stroke caused by focal cerebral arteriopathy in children

目的探讨儿童局灶性脑动脉病致动脉缺血性卒中的临床表现、影像学特征以及预后。方法回顾性分析2016年8月至2020年6月复旦大学附属儿科医院神经外科收治的15例局灶性脑动脉病致卒中患儿的临床资料。总结15例患儿的临床表现、影像学特征、治疗方法和预后情况。临床随访采用门诊和电话随访方式,通过儿童卒中预后量表(PSOM)评估患儿的神经功能预后,通过临床和影像学随访结果评估患儿有无卒中复发。结果15例患儿的中位年龄为6.5岁(1.9~12.8岁);其中男7例,女8例。临床症状包括偏瘫12例,失语5例,头痛3例,癫痫1例。狭窄病变位于颈内动脉(ICA)C1~C7段5例,ICA C1~C7段+大脑前动脉(ACA)A1段+大脑中动脉(MCA)M1段1例,ICA C6~C7段+ACA A1段+MCA M1段7例,ACA A1段、MCA M1段各1例。15例患儿的梗死灶与动脉病变均位于同侧,其中左侧10例,右侧5例;梗死灶位于基底核区9例,额叶6例,颞叶5例,顶叶5例,岛叶1例,丘脑1例,其中8例患者的脑梗死范围包含≥2个脑叶。入院时儿童国立卫生研究院卒中量表(PedNIHSS)评分中位数为4分(范围为0~10分)。15例患儿急性期均采用扩容治疗,恢复期4例患儿采用抗血小板药物治疗,11例行临床观察。所有患儿均获得随访,中位随访时间为14.5个月(3.5~58.4个月)。13例患儿的神经功能预后良好(PSOM评分<1分),2例预后不良(PSOM评分为1分)。随访期间无一例死亡或发生动脉缺血性卒中复发。结论儿童局灶性脑动脉病是一类非进展性疾病,偏瘫为该病所致卒中最常见的临床症状,动脉病变常见于颈内动脉,经恰当地处理后患儿的临床预后较好。

Objective To explore the clinical manifestations,imaging features and prognosis of arterial ischemic stroke caused by focal cerebral arteriopathy in children.Methods A retrospective analysis was conducted on the clinical data of 15 children with focal cerebral arteriopathy who were admitted to the Department of Neurosurgery,Children's Hospital of Fudan University from August 2016 to June 2020.The clinical manifestations,imaging features,treatment and outcomes of 15 children were summarized.The clinical follow-up was performed through outpatient clinic visits and telephone.The outcome of children's neurological function was assessed based on the Pediatric Stroke Outcome Measure(PSOM),and the clinical and imaging follow-up results were used to assess whether the child had recurrence of stroke.Results The median age of 15 children was 6.5 years(range:1.9-12.8 years);7 were males and 8 were females.The clinical symptoms included 12 cases of hemiplegia,5 cases of aphasia,3 cases of headache,and 1 case of epilepsy.The stenotic lesions were located in the internal carotid artery(ICA)C1-G7 segment in 5 cases,ICA C1-C7+anterior cerebral artery(ACA)A1+middle cerebral artery(MCA)M1 segment in 1 case,ICA C6-C7+ACA A1+MCA M1 segment in 7 cases,1 case each in ACA A1 and MCA M1 segment.The infarctions and arterial lesions of 15 children were all located on the same side,including 10 on the left side and 5 on the right side.The infarction was located in the basal ganglia in 9 cases,in the frontal lobe in 6 cases,in the temporal lobe in 5 cases,in the parietal lobe in 5 cases,in the insula in 1 case,and in the thalamus in 1 case.Among them,8 patients had cerebral infarction involving≥2 lobes.The median score of the Pediatric National Institutes of Health Stroke Scale(PedNIHSS)at admission was 4 points(range;0-10 points).All 15 patients underwent volume expansion therapy in the acute stage,4 patients were treated with antiplatelet drugs in the convalescent stage,and 11 patients underwent clinical observation.All children were followed up,with a median follow-up time of 14.5 months(range;3.5-58.4 months).The neurological function of 13 children had a good outcome(PSOM score<1 point),and 2 had a poor outcome(PSOM score of 1 point).During the follow-up period,there was no death or recurrence of arterial ischemic stroke.Conclusions Focal cerebral arteriopathy in children is a non-progressive disease.Hemiplegia is the most common clinical symptom.Arteriopathy is common in the ICA.After proper treatment,the clinical prognosis of children seems good.