小儿脑囊虫病22例分析

目的：研究小儿脑囊虫病的临床表现及治疗。方法：对22例小儿脑囊虫病患者进行临床分析。结果：根据临床表现分为惊厥型14例,头痛型4例,脑炎型3例,混合型1例。头颅CT检查均有异常发现,免疫学检查皮内试验阳性为10例,血液抗体检查阳性为15例,抗原阳性为12例。治疗用方案1：吡喹酮及强的松口服,6 d为1疗程;方案2：丙硫咪唑及强的松口服,10 d为1个疗程。全部病例均用3～4个疗程。有效率100%,均未观察到副反应。结论：头部影像学检查(CT或MRI)及免疫学检查对诊断有重要价值,吡喹酮、丙硫咪唑对小儿脑囊虫病的治疗是有效、安全的。     

150例小儿脑性瘫痪的临床、CT与磁共振分析

研究目的 探讨小儿脑瘫患者CT及磁共振(MRI)形态学改变。 研究方法 对150例脑瘫患儿进行CT与MRI检查,并对其结果进行分析。 结果 150例中,CT异常者97例,占64.65%。弥漫性脑萎缩(42例)、脑软化灶(24例)、脑穿通畸形(9例)、局限性脑萎缩(7例)等是儿童脑瘫常见的CT形态学改变。CT检查正常者53例中,30例行MRI检查,异常25例,占83.3％。脑白质髓鞘形成延迟(14例)是主要的MRI形态学异常。 结论 CT和MRI检查对小儿脑瘫的病因学诊断有重要价值,两者结合可提高诊断符合率。     

脑室超声检查对婴儿脑性瘫痪诊断价值的探讨

目的探讨脑室改变与脑性瘫痪(脑瘫)高危因素、病情、病型及并发症的关系。方法对42例脑瘫婴儿的超声表现进行分析，并与头颅CT比较。结果脑瘫患儿脑室扩张率81.0%(34/42)，且与病情程度密切相关(P＜0.01)，脑室扩张与病型及并发症无关，但与高危因素有关，有颅内出血高危因素的患儿脑室扩张率达100%，且多为重度扩张。超声与头颅CT诊断符合率为87.0%。结论超声检查婴儿脑室系统是早期诊断脑瘫较灵敏的辅助手段。     

小儿脑型肺吸虫病的诊治

目的 探讨小儿脑型肺吸虫病的临床特点和诊治.方法 59例患儿中生食淡水蟹或饮用疫水52例,高颅压症状49例,肢体偏瘫19例,偏盲10例,癫痫发作19例,合并肺部症状6例;外周血嗜酸性粒细胞升高45例,白细胞升高36例;肺吸虫抗原皮试阳性55例,ELISA试验阳性15例.CT或MRI检查均发现脑内病灶.结果 所有病例均口服吡喹酮治疗,其中14例手术开颅切除病灶.痊愈41例,好转18例.43例患儿随访6～12个月预后良好.结论 小儿脑型肺吸虫病临床表现多样,早期易误诊.流行病学资料、外周血嗜酸性粒细胞升高、肺吸虫免疫学检查和MRI有助于早期诊断.根据病情采用药物及手术治疗效果满意.     

儿童Caroli's病8例

目的 探讨儿童Caroli's病的临床特点及诊断方法 ,以提高对该病的认识.方法 回顾性分析本院1998年2月-2007年12月收治的8例Caroli's病患儿临床资料、实验室检查及影像学表现,8例均行腹部B超及cT检查.结果 Caroli's患儿男5例,女3例;平均年龄6.3岁.病史5 d～4个月.临床表现分别为肝脾大5例,呕血伴腹痛3例,发热伴尿色混浊1例.8例中5例属门静脉周围纤维化型,患儿有不同程度的肝硬化,5例肝脾大,其中3例出现门静脉高压,1例有胆囊炎.余3例为单纯型,其中1例并婴儿型多囊肾.实验室检查2例肝功能异常,1例肾功能异常.影像学检查示肝大,肝实质内散在多发不规则无回声区,与胆管相连.CT检查可见"中心点"征,为特异性征象.1例可见食管胃底静脉明显扩张.本组8例均采用保守治疗,无1例手术治疗.结论 Caroli's病临床表现多样,对于腹痛及肝大的患儿尤应注意.B超及CT检查对诊断Caroli's病具有重要价值,有助于早期明确诊断.可采取保守或手术治疗.     

脑型脚气病24例CT结果及临床分析

目的探讨头部CT对脑型脚气病的诊断价值。方法回顾分析24例婴幼儿脑型脚气病临床及CT表现。结果24例患儿主要临床表现为精神萎靡、惊厥、嗜睡、声嘶及呛奶。头部CT表现为双基底节对称性(21例)或单侧基底节(3例)低密度影。结论头部CT基底节腔隙性脑梗塞可作为诊断脑型脚气病的依据之一。     

不同病期小儿结核性脑膜炎神经影象学改变与临床的关系

为了解不同病期结核性脑膜炎（TM）患儿的头颅CT、MRI改变及与临床的关系，对91例不同病期TM患儿的头颅CT、MRI及临床进行分析。结果头颅CT检查67例，异常58例，异常率为86．6％；头颅MRI检查38例，异常35例，异常率为92．1％。CT改变特点与MRI基本一致，早期公为脑池改变或轻度脑实质低密度影；中期则发展为脑水肿、脑积水；晚期可见脑实质低密度、混杂高密度影及脑池受压、闭塞、粘连等。临床疗效良好者影像学改变轻，疗效差者影像学改变重。提示CT、MRI检查，尤其MRI对TM的诊断、病期和预后判定有重要意义。     

儿童脑囊虫病15例分析

脑囊虫病是猪囊尾蚴寄生在人脑的一种疾病，多见于成人，儿童发病率低，但近年来有不少儿童脑囊虫病的报道．为提高对本病的认识，我们对我科1994-2002年收治的15例儿童脑囊虫病，进行了回顾总结，现分析如下。     

儿童脑性瘫痪CT形态学改变与临床关系的分析

研究目的 探讨儿童脑性瘫痪CT形态学改变与临床的关系。 研究方法 儿童脑瘫患者100例,男66例,女34例。所有患者共分为5个年龄组,分别行颅脑CT检查。 结果 儿童脑瘫多发于6个月～3岁间。100例患儿中CT扫描异常者73例,异常率为73％。脑室周萎缩(PVL)为最常见的CT形态学改变,共23例。中间部异常18例,皮质或皮质下萎缩20例,其它改变 13例。CT扫描正常者(27例)症状大多较轻,较严重的PVL,脑皮质及皮质下缩萎、脑囊性变,临床上多有严重的运动障碍。 结论 CT形态学检查对儿童脑瘫患者的诊断及预后判定具有重要意义。     

儿童脑胶质瘤53例

目的 总结儿童脑胶质瘤的临床特点,评价CT、MRI对该病的诊断价值.方法 回顾性分析河南省人民医院神经外科2001年1月-2006年12月收治的14岁以下、经临床诊断为脑胶质瘤的53例患儿.分析其年龄、性别、临床症状和体征、影像学检查、病理检查特点和诊断治疗情况.结果 1.本组资料中男35例,女18例;2.头痛头晕、恶心呕吐各32例(各60.4%),有平衡功能障碍者31例(58.5%),有发作性肢体抽搐者6例(11.3%),眼底改变者33例(62.3%);3.发病部位在大脑幕上24例(45.3%),幕下29例(54.7%);4.行颅脑CT检查33例,漏诊1例,阳性率达97%.行MRI检查28例,均发现异常,检出率为100%;5.行病理检查的42例患儿,其中星形细胞瘤17例,髓母细胞瘤l3例,分别占40.5%、31.0%.结论 1.儿童脑胶质瘤发病男多于女;2.儿童脑胶质瘤易引起头痛头晕、恶心呕吐、眼底改变等颅内压增高表现,可能与肿瘤好发于后颅凹及中线有关;3.儿童脑胶质瘤好发于幕下,易出现走路不稳等平衡功能障碍表现,可能与病变累及小脑等结构有关;4.颅脑CT和MRI仍是目前诊断儿童颅内肿瘤的重要手段,MRI的诊断价值优于CT;5.儿童脑胶质瘤的组织学类型与成人差别明显,以星形细胞瘤和髓母细胞瘤为多见.     

Comparison of patients with Kawasaki disease with retropharyngeal edema and patients with retropharyngeal abscess

Kawasaki disease with retropharyngeal edema (KD with RPE) is a rare complication, and it is diagnosed by neck CT. Most reported cases had a delayed diagnosis because those patients' conditions were misdiagnosed as retropharyngeal abscess (RPA). The purpose of this study was to differentiate KD with RPE from RPA. We performed a retrospective case–control study comparing children with KD with RPE to those with RPA hospitalized at the tertiary pediatric hospital in Tokyo between 2005 and 2011. The 39 patients revealing RPE on neck CT were divided into two groups: group A was classified as KD (n?=?21) and group B was classified as non-KD (n?=?18). Patients in group B were finally evaluated as having RPA clinically and were treated with antibiotic therapy. A significantly higher proportion of patients in group B complained of dysphagia (11 patients vs. 5 patients; p?=?0.0170) and neck pain (17 patients vs. 12 patients; p?=?0.0106). Neck CT revealed a ring enhancement (16 patients vs. no patients; p?<?0.0001) and mass effect in a greater proportion of patients in group B (11 patients vs. 1 patient; p?<?0.0003). Conclusion: Careful attention to manifestations and close analyses of CT imaging may allow clinicians to differentiate KD with RPE from RPA.     

Patients with moyamoya disease presenting with movement disorder

Moyamoya disease is a rare cerebrovascular disease characterized by idiopathic bilateral stenosis or occlusion of bilateral internal carotid arteries and the development of characteristic leptomeningeal collateral vessels at the base of the brain. Typical presentations include transient ischemic attacks or stroke, and hemorrhage. Presentation with movement disorders is extremely rare, especially in the pediatric population. The authors describe the cases of 4 children with moyamoya disease who presented with movement disorders. Among 446 patients (118 pediatric) with moyamoya disease surgically treated by the senior author, 4 pediatric patients had presented with movement disorders. The clinical records, imaging studies, surgical details, and postoperative clinical and imaging data were retrospectively reviewed. The initial presenting symptom was movement disorder in all 4 patients: chorea in 2, hemiballismus in 1, and involuntary limb shaking in 1. All the patients had watershed infarcts involving the frontal subcortical region on MR imaging. Additionally, 1 patient had a ganglionic infarct. Single-photon emission computed tomography studies showed frontoparietal cortical and subcortical hypoperfusion in all patients. Three patients had bilateral disease, whereas 1 had unilateral disease. All the patients underwent superficial temporal artery-middle cerebral artery bypass. Postoperatively, all 4 patients had complete improvement in their symptoms. The SPECT scans revealed normal perfusion in 3 patients and a small residual perfusion deficit in 1. Movement disorders are a rare presenting feature of moyamoya disease. Hypoperfusion of the frontal cortical and subcortical region was seen in all patients, and the symptomatology was attributed to ischemic dysfunction and imbalance in the cortical-subcortical-ganglionic-thalamic-cortical circuitry. Combined revascularization with superficial temporal artery-middle cerebral artery bypass and encephaloduroarteriosynangiosis leads to excellent results.     

Treatment with probucol of children with familial hypercholesterolaemia

Nine children with familial hypercholesterolaemia, age range 2 to 12 years, were treated with a low cholesterol diet and probucol (10 mg/kg/day). The year before, the children received, as only treatment, a low fat-cholesterol diet. During this period their mean plasma total cholesterol level fell from 8.2 +/- 1.45 mmol/l to 7.17 +/- 0.84 mmol/l (12.6%). This level was further reduced to 5.92 +/- 0.63 mmol/l (17.1%) after the addition of probucol. Plasma high density lipoprotein cholesterol levels were lowered in absolute terms but not in relation to total cholesterol. No apparent side effects were observed. However, the use of probucol should be restricted for the moment to severe cases of hypercholesterolaemia as the long-term excretion of the drug in children is not yet known.