新生儿脑梗死的临床特征及其与预后关系的研究

目的分析新生儿脑梗死的临床特征与预后的关系,并通过早期诊断和干预,以改善本病的远期预后。方法总结6例确诊病例的临床特征,进行围产期因素和其它可能病因分析,并对存活患儿进行6～8个月的随访。结果1年内发现6例新生儿脑梗死,占同期住院患儿0．6％(6／969)。6例中3例经MRA确诊为脑血管畸形,1例为严重脑室内出血,1例与早产、母亲患重度妊娠高血压综合征及继发于支气管肺发育不良的呼吸衰竭等综合因素有关,1例原因不明。本组4例(4／6)出现各种形式惊厥,占同期新生儿惊厥的20％(4／20),是引起新生儿惊厥的第二位原因;6例在早期均无定位体征,仅有部分患儿表现为肌张力异常。头颅B超示6例中5例有阳性发现;弥散加权核磁共振成像(DW-MRI)能够做到早期准确诊断。1例随访至1岁未发现异常,其余5例均有不同程度不良预后。结论新生儿脑梗死并不少见,而且是新生惊厥的重要原因之一,影像检查是本病主要确诊方法,未能早期诊治和累及范围较广者预后不良。

Diagnosis and prognosis of neonatal cerebral infarction

Objective To analyze the relationship between clinical characteristics and prognosis of neonatal cerebral infarction and to draw attention to the disease to improve the long term outcome through early diagnosis and intervention. Methods The clinical characteristics of 6 confirmed cases were summarized. Perinatal conditions and other factors were analyzed for possible causes of the disease. The survived patients were followed up for 6 8 months.Results The authors diagnosed 6 cases of neonatal cerebral infarction in one year, which accounted for 0 6% (6/969)of all the in patients in the same time period. Among them 3 cases were confirmed as cerebrovascular malformations by magnetic resonance angiography (MRA), In 1 case the infarction was due to severe bilateral intraventricular hemorrhage, and in another case the disease was related to comprehensive factors such as prematurity, maternal pregnancy induced hypertension and respiratory failure secondary to bronchopulmonary dysplasia (BPD), and in 1 case the cause was undetermined. Four out of the 6 patients presented with varied forms of convulsions, which became the second leading cause for all the neonatal convulsive events (20%). None of the patients had localized neurological signs in the early course except for abnormal muscular tone of some extent. Cerebral ultrasound scanning in 5 out of 6 cases showed positive results. The diffusion weighted magnetic resonance imaging (DW MRI) was highly valuable for early confirmative diagnosis. Only one case was found normal within one year of follow up and all the other 5 cases had unfavorable prognoses of varied severity.Conclusion Neonatal cerebral infarction is not a rare condition and should be considered as one of the important causes for neonatal convulsion. Imaging study is the main technique for diagnosis. The prognoses were poor for those cases for whom early diagnosis and treatment can not be made or those with widespread cerebral lesions.