Govaert P, Matthys E, Zecic A, Roelens F, Oostra A, Vanzieleghem B
Department of Neonatology, Gent University Hospital, Gent, Belgium.
Arch Dis Child Fetal Neonatal Ed. 2000 Jan;82(1):F59-63. doi: 10.1136/fn.82.1.f59.
To define neonatal pial middle cerebral artery infarction.
A retrospective study was made of neonates in whom focal arterial infarction had been detected ultrasonographically. A detailed study was made of cortical middle cerebral artery infarction subtypes.
Forty infarctions, with the exception of those in a posterior cerebral artery, were detected ultrasonographically over a period of 10 years. Most were confirmed by computed tomography or magnetic resonance imaging. Factor V Leiden heterozygosity was documented in three. The onset was probably antepartum in three, and associated with fetal distress before labour in one. There were 19 cases of cortical middle cerebral artery stroke. The truncal type (n=13) was more common than complete (n = 5) middle cerebral artery infarction. Of six infarcts in the anterior trunk, four were in term infants and five affected the right hemisphere. Clinical seizures were part of the anterior truncal presentation in three. One of these infants, with involvement of the primary motor area, developed a severe motor hemisyndrome. The Bayley Mental Developmental Index was above 80 in all of three infants tested with anterior truncal infarction. Of seven patients with posterior truncal infarction, six were at or near term. Six of these lesions were left sided. Clinical seizures were observed in three. A mild motor hemisyndrome developed in at least three of these infants due to involvement of parieto-temporal non-primary cortex.
Inability to differentiate between truncal and complete middle cerebral artery stroke is one of the explanations for the reported different outcomes. Severe motor hemisyndrome can be predicted from neonatal ultrasonography on the basis of primary motor cortex involvement. Clinical seizures were recognised in less than half of the patients with truncal infarction; left sided presentation was present in the posterior, but not the anterior truncal type of infarction. Asphyxia is a rare cause of focal arterial infarction.
明确新生儿软膜大脑中动脉梗死。
对超声检查发现局灶性动脉梗死的新生儿进行回顾性研究。对皮质大脑中动脉梗死亚型进行详细研究。
在10年期间，超声检查发现40例梗死，后交通动脉梗死除外。多数经计算机断层扫描或磁共振成像证实。3例记录有凝血因子V莱顿杂合子。3例发病可能在产前，1例与产程中胎儿窘迫相关。有19例皮质大脑中动脉卒中。主干型（n = 13）比完全型（n = 5）大脑中动脉梗死更常见。在前主干的6例梗死中，4例为足月儿，5例累及右半球。3例前主干型患儿有临床惊厥表现。其中1例累及初级运动区的婴儿出现严重运动性偏瘫综合征。3例接受前主干梗死检查的婴儿，贝利智力发育指数均高于80。7例后主干梗死患者中，6例为足月儿或接近足月儿。其中6例病变在左侧。3例有临床惊厥表现。这些婴儿中至少3例因顶颞非初级皮质受累出现轻度运动性偏瘫综合征。
无法区分主干型和完全型大脑中动脉卒中是报道的不同预后的原因之一。根据初级运动皮质受累情况，可通过新生儿超声预测严重运动性偏瘫综合征。主干梗死患者中不到一半有临床惊厥表现；后主干型梗死以左侧受累为主，前主干型则不然。窒息是局灶性动脉梗死的罕见原因。
