儿童动脉缺血性卒中50例病例系列报告

背景：近年来儿童卒中的发病率显著增长，其中动脉缺血性卒中比例居多，儿童缺血性卒中的病因与成人不同，早期识别、及时对因治疗，能显著降低致残率。目的：分析儿童动脉缺血性卒中的常见病因、临床特点、影像学特点、治疗及预后，为早期诊断提供依据。设计：病例系列报告。方法：对2017年4月至2019年7月在北京天坛医院儿科及神经内科、神经外科就诊的动脉缺血性卒中患儿临床资料进行回顾性分析。主要结局指标：儿童动脉缺血性卒中的病因和临床表现。结果：50例患儿纳入本文分析，男29例，女21例。发病年龄9个月至17岁，平均年龄（8.8±3.9）岁，7~10岁21例（42%）。病因包括烟雾病39例（78%），感染5例（10%），头部外伤3例（6%），血管炎、心脏病和未找到明确病因各1例（2%）。卒中发作时47例（94%）表现为肢体瘫痪，感觉减退或麻木、语言障碍各9例（18%），其他表现包括中枢性面瘫、意识障碍、癫等。神经影像学检查提示梗死灶位于多发脑叶19例（38%）、基底节区15例（30%）、单发脑叶10例（20%），脑干1例（2%），多发病灶（基底节、脑叶、小脑及脑干）5例（10%）。数字减影血管造影（DSA）提示前循环受累34例，其中23例（67.6%）大脑中动脉狭窄或闭塞。结论：学龄期是儿童动脉缺血性卒中发病高峰，肢体瘫痪为最常见的临床表现，烟雾病和感染是主要病因，前循环受累较后循环多见，其中大脑中动脉供血区缺血梗死最常见。

50 cases of arterial ischemic stroke in children:A case series report

Background：The incidence of stroke in children has increased significantly in recent years and arterial ischemic stroke is the most common one. The causes of ischemic stroke in children are different from those in adults. Early recognition and timely treatment can significantly reduce the disability rate. Objective：To analyze the etiology, clinical features, imaging characteristics, treatment and prognosis of ischemic stroke in children in order to provide reference to early diagnosis. Design：Case series report. Methods：The clinical data of 50 children with arterial ischemic stroke who were hospitalized in Beijing Tiantan Hospital Affiliated to the Capital Medical University from April 2017 to July 2019 were analyzed retrospectively. Main outcome measures：Etiology and clinical manifestations of arterial ischemic stroke in children. Results：There were 29 boys and 21 girls with mean onset age of 8.8±3.9 years (9 months to 17 years old). The peak incidence was in children aged 7 to 10 years (21 cases, 42%). Etiology included moyamoya disease(78%), infection (10%), trauma(6%), vascular disease(2%), cardiac disease(2%). One case had no identifiable cause. The most frequent clinical manifestation was hemiplegia (94%). Abnormal feeling and language disorder were found in 9 cases(18%), respectively. Other neurological manifestations included central facial paralysis, disturbance of consciousness and epilepsy. Neuroimaging results showed that the cerebral infarction was located in multiple lobes for 19 cases (38%), basal ganglia for 15 cases (30%), single lobes for 10 cases (20%) , brain stem for 1 case (2%) , and multiple lesions (basal ganglia, lobe, cerebellum and brainstem) for 5 cases (10%). Digital subtraction angiography (DSA) showed that anterior circulation was involved in 34 cases with 23 of middle cerebral artery stenosis or occlusion. Conclusion：The peak onset of arterial ischemic stroke in children occurred in school age. Hemiplegia is the most common neurological manifestation. Moyamoya disease and infection were the main causes of stroke in this group. Anterior circulation is more easily involved than posterior circulation and ischemic infarction is the most common in the middle cerebral artery blood supply area.