Rosman N Paul, Adhami Seema, Mannheim Glenn B, Katz Nathaniel P, Klucznik Richard P, Muriello Mary Anne
Department of Pediatrics, The Floating Hospital for Children, Tufts-New England Medical Center, Tufts University School of Medicine, Boston, MA 02111, USA.
J Child Neurol. 2003 Jul;18(7):450-62. doi: 10.1177/08830738030180070601.
Basilar artery occlusion in children is rare. The clinical diagnosis of basilar artery occlusion is often difficult because the initial neurologic findings, most frequently hemiparesis, involuntary movements, or headache, are often transient and can suggest complicated migraine, seizures, or both. We have reviewed 37 previously reported pediatric cases of basilar artery occlusion and present 3 additional ones. In the 40 cases, basilar artery occlusion alone occurred in 22; in the other 18, there was accompanying vertebral artery occlusion. In the cases of pure basilar artery occlusion, the most common causes were trauma and arteritis, but in most such cases, the etiology could not be determined. The cause was found much more often in cases of basilar artery occlusion with accompanying vertebral artery occlusion, with trauma being the most frequent etiology, especially in boys between 6 and 14 years. Of the 37 previously reported pediatric cases of basilar artery occlusion, 7 were "locked in" early in the course (mute, quadriparetic, aware, and communicative with eye movements), as were our 3 cases. In most cases of basilar artery occlusion that are locked in, the basilar artery occlusion involves its midportion, sparing the anterior inferior cerebellar and superior cerebellar arteries.
儿童基底动脉闭塞较为罕见。基底动脉闭塞的临床诊断往往困难，因为最初的神经系统表现，最常见的是偏瘫、不自主运动或头痛，通常是短暂的，可能提示复杂性偏头痛、癫痫发作或两者皆有。我们回顾了37例先前报道的儿童基底动脉闭塞病例，并另外报告3例。在这40例病例中，单纯基底动脉闭塞发生在22例；在另外18例中，伴有椎动脉闭塞。在单纯基底动脉闭塞的病例中，最常见的病因是创伤和动脉炎，但在大多数此类病例中，病因无法确定。在伴有椎动脉闭塞的基底动脉闭塞病例中，病因更容易找到，创伤是最常见的病因，尤其是在6至14岁的男孩中。在先前报道的37例儿童基底动脉闭塞病例中，7例在病程早期出现“闭锁综合征”（缄默、四肢瘫痪、意识清醒且可通过眼球运动交流），我们的3例病例也是如此。在大多数出现“闭锁综合征”的基底动脉闭塞病例中，基底动脉闭塞累及其中段，小脑前下动脉和小脑上动脉未受影响。
