Objective: To summarize and analyze the etiology, clinical manifestations and imaging features of children with cerebral infarction.
Methods: A retrospective analysis was performed for the clinical data of 54 children with cerebral infarction, including etiology, clinical manifestations, distribution of infarcts, type of infarcts and clinical outcome.
Results: Of the 54 children, 93% had a clear cause, among whom 46% had the coexistence of multiple factors, and the top three causes were infection (54%), vascular disease (40%) and trauma (26%). Major clinical manifestations included limb paralysis (85%), pyrexia (20%), disturbance of consciousness (19%) and convulsion (17%). As for the location of infarcts, 80% of the infarcts were located in the cerebral cortex and 52% in the basal ganglia. Major types of infarcts were small-area infarcts (74%) and multifocal infarcts (56%). Viral encephalitis was the most common cause of cerebral infarction caused by infection, with the cerebral cortex as the most common location of infarcts (21/23, 91%) and multiple infarcts as the most common type of infarcts (13/23, 57%). Among the 12 children with cerebral infarction caused by nonspecific endarteritis, 10 (83%) had infarcts located in the basal ganglia and only one child had multiple infarcts. Among the five children with cerebral infarction caused by moyamoya disease, four children (80%) had infarcts located in the cerebral cortex, and large-area infarction (4/5, 80%) and multifocal infarction (4/5, 80%) were the major types of infarcts. Among the children with traumatic cerebral infarcts, 92% had infarcts located in the basal ganglia, and small-area infarcts (92%) and single infarcts (85%) were the major types of infarcts. Among the 46 children with limb paralysis, 34 (74%) had infarcts located in the basal ganglia; 50% of the children with disturbance of consciousness had infarcts located in the basal ganglia. Subcortical infarcts were observed in all six children with epilepsy. Seventy-five percent of the infarcts located in the cerebral cortex and 87% of the infarcts located in the basal ganglia had a good prognosis. Among the two children with cerebral infarcts located in the brainstem, one had the sequela of hemiplegia and the other had the sequela of cognitive impairment. Eighty-eight percent of the children with cerebral infarction caused by infection and 82% of the children with traumatic cerebral infarction tended to have a good prognosis, and 83% of the children with cerebral infarction caused by nonspecific endarteritis had good prognosis. Recurrence was observed in all three children with cerebral infarction caused by vascular malformations. Of the five children with cerebral infarction caused by moyamoya disease, one child died and four children survived with the sequela of localized brain atrophy, among whom one child also had the sequela of epilepsy.
Conclusions: Infection, vascular disease and trauma are the most common causes of cerebral infarction in children, and limb paralysis is the most common clinical manifestation. Cerebral cortex is the most common infarct site, and small-area infarcts and multifocal infarcts are the most common types of infarcts, which tend to have a better prognosis.
目的: 总结分析儿童脑梗死的病因、临床表现、影像学特点。
方法: 以54例脑梗死患儿为研究对象，对病因、临床表现、梗死灶部位分布、梗死灶类型及临床转归进行回顾性分析。
结果: 93%的脑梗死患儿病因明确，其中46%的患儿多种因素共存，前三位病因为感染（54%）、血管病变（40%）、外伤（26%）。主要临床表现为肢体瘫痪（85%）、发热（20%）、意识障碍（19%）、抽搐（17%）等。病灶部位以大脑皮质（80%）最多见，其次为基底节区（52%）；病灶类型以小面积（74%）、多灶性（56%）梗死为主。感染所致的脑梗死以病毒性脑炎最多，其病灶部位以大脑皮质最常见（91%），病变类型以多灶性梗死较多（57%）。非特异性脑动脉内膜炎引起的脑梗死中83%的梗死灶位于基底节区，仅1例为多发梗死灶。烟雾病所致的脑梗死病灶部位以大脑皮质最常见（80%），病灶类型以大面积梗死（80%）和多灶性梗死（80%）多见。外伤患儿梗死灶以基底节区最常见（92%），病变类型以小面积梗死（92%）和单发梗死（85%）多见。肢体瘫痪的患儿病灶部位多位于基底节区（74%），意识障碍的患儿中50%梗死灶位于基底节区，癫痫的（100%）患儿均可见皮层下梗死。梗死灶位于大脑皮质的75%预后良好；梗死灶位于基底节区的87%预后良好；2例梗死灶位于脑干的患儿中1例遗留偏瘫、1例遗留认知障碍。感染所致的患儿88%预后良好；外伤所致的患儿82%预后良好；非特异性脑动脉内膜炎所致的患儿83%预后良好；脑血管畸形所致的患儿100%复发；5例烟雾病引起的脑梗死患儿中1例死亡，存活的4例患儿均遗留局限性脑萎缩、其中1例遗留癫痫。
结论: 儿童脑梗死多由感染、血管病变、外伤所致，肢体瘫痪最为常见，梗死灶部位以大脑皮质区常见，病变类型以小面积、多灶性梗死常见，预后较好。