儿童动脉缺血性卒中临床特征分析

Retrospective analysis of pediatric arterial ischemic stroke

目的总结儿童动脉缺血性卒中(pediatric arterial ischemic stroke,PAIS)的临床特征。方法选取2015年7月至2020年4月首都医科大学附属北京儿童医院收治的109例PAIS患儿,对其临床资料进行回顾性分析,总结临床表现、病灶分布、病因及出院时转归情况。结果男女比约2:1,年龄1个月至15岁,中位年龄3岁11个月。最常见的临床症状为肢体瘫痪(92例,84.4%),以偏瘫为主(74.3%),其他常见症状包括中枢性面瘫(59例,54.1%)、失语或构音障碍(42例,38.5%)、抽搐(37例,33.9%)、中枢性呼吸衰竭(18例,16.5%)、意识障碍(17例,15.6%)和头痛(10例,9.2%)等。影像学检查中,MRI阳性检出率达100%,而CT为90.5%,其中大脑前循环卒中最多见(72.6%),后循环卒中(14.2%)及混合卒中(13.2%)相对少见,62.3%的病例为单支血管受累,以大脑中动脉梗死最常见(57例,53.8%),37.7%的病例为多支血管受累。最常见的病因为头颈部创伤(23.9%)及颅内动脉病变(23.9%),其次为心脏疾病(13.8%)、感染性疾病(12.8%)等,仍有12.8%的病例病因不明。出院时症状基本消失26例(23.9%),症状改善50例(45.9%),无明显改善者13例(11.9%),死亡4例(与PAIS相关死亡3例)。结论PAIS常以局灶性神经功能受损为主要临床表现,头颈部创伤、颅内血管病变和心脏疾病是常见病因。病灶分布以大脑前循环卒中最多,多数预后较好,部分可遗留神经系统后遗症。

Objective To summarize the clinical characteristics of pediatric arterial ischemic stroke(PAIS).Methods A total of 109 patients who were diagnosed with PAIS at the Department of Emergency,Beijing Children’s Hospital,Capital Medical University,from July 2015 to April 2020 were enrolled in the study.The clinical manifestations,focus distribution,etiology and discharge outcome of the PAIS patients were analyzed.Results The ratio of male and female patients was 2:1 and the age was from one month to 15 years old with a median age of 47 months.The most common clinical symptoms were paralysis(84.4%),and mainly hemiplegia(74.3%).Other common clinical symptoms were central facial paralysis(54.1%),aphasia or dysarthria(38.5%),convulsion(33.9%),central respiratory failure(16.5%),disturbance of consciousness(15.6%),headache(9.2%).Among the intracranial ischemic lesions confirmed by imaging,anterior cerebral circulation stroke was the most common(72.6%),posterior circulation stroke(14.2%)and mixed stroke(13.2%)were relatively rare.In most cases,single angiopathy was involved(62.3%),and middle cerebral artery infarction was the most common(53.8%).The proportion of the patients who had multiple angiopathy was 37.7%.The most common causes were trauma and intracranial arterial lesions(23.9%),followed by heart disease(13.8%),infectious disease(12.8%),12.8% was unknown.Upon discharge,the symptoms of 26 patients(23.9%)basically resolved and the symptoms of 50 patients(45.9%)improved,13 patients(11.9%)had no significant improvement.Three cases related to PAIS among the four dead patients.Conclusions Focal neurological impairment is the main clinical manifestation of PAIS.Intracranial arterial diseases,trauma and heart disease are the common causes.Anterior cerebral circulation stroke is the most common lesion.Most of the children have good outcomes after treatments,but some of them have neurological sequelae.