Dagartzikas Maria I, Sprague Kelly, Carter Guy, Tobias Joseph D
Department of Child Health, The University of Missouri, Columbia, Missouri 65212, USA.
Pediatr Emerg Care. 2002 Feb;18(1):33-5. doi: 10.1097/00006565-200202000-00011.
Cerebral infarction in children may be the result of various disease processes, including emboli from intracardiac sources, paradoxical emboli from the venous system, sickle cell disease, cyanotic heart disease, vasculitis affecting the carotid or cerebral vascular system, vascular anomalies, and prothrombotic states. We present a previously healthy adolescent who presented with the acute onset of hemiparesis. Work-up revealed a dilated cardiomyopathy with a left ventricular mural thrombus as the etiology of his cerebrovascular event. Although dilated cardiomyopathy (DCM) may predispose to the development of a mural thrombus and subsequent embolic events, there are no previous reports in pediatric-aged patients of the development of an embolic event as the presenting manifestation of DCM. Further investigation of the etiology of the DCM led to the diagnosis of a pheochromocytoma. Congestive heart failure and DCM as the presenting sign of pheochromocytoma has likewise not been reported in a pediatric-aged patient. We review this unlikely sequence of events, the diagnostic evaluation of such patients, and treatment options.
儿童脑梗死可能是多种疾病过程的结果，包括心内源性栓子、静脉系统的反常栓子、镰状细胞病、青紫型心脏病、影响颈动脉或脑血管系统的血管炎、血管异常以及血栓前状态。我们报告一名既往健康的青少年，他急性起病出现偏瘫。检查发现扩张型心肌病伴左心室壁血栓，这是其脑血管事件的病因。尽管扩张型心肌病（DCM）可能易导致壁血栓形成及随后的栓塞事件，但此前尚无关于儿童患者以栓塞事件作为DCM首发表现的报道。对DCM病因的进一步调查导致诊断为嗜铬细胞瘤。充血性心力衰竭和DCM作为嗜铬细胞瘤的首发体征在儿童患者中同样未见报道。我们回顾这一不太可能发生的事件序列、此类患者的诊断评估及治疗选择。
