Salih Mustafa A, Abdel-Gader Abdel-Galil M, Al-Jarallah Ahmed A, Kentab Amal Y, Alorainy Ibrahim A, Hassan Hamdy H, Al-Nasser Mohammed N
Division of Pediatric Neurology, Department of Pediatrics, College of Medicine, King Saud University, PO Box 2925, Riyadh 11461, Kingdom of Saudi Arabia.
Saudi Med J. 2006 Mar;27 Suppl 1:S35-40.
To describe the clinical features and presentations of perinatal stroke in a prospective and retrospective cohort of Saudi children and ascertain the risk factors.
Patients with perinatal stroke were identified from within a cohort of 104 Saudi children who were evaluated at the Division of Pediatric Neurology at King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, Saudi Arabia from July 1992 to February 2001 (retrospective study) and February 2001 to March 2003 (prospective study). Neuroimaging for suspected cases of stroke consisted of cranial CT, MRI, or both.
During the study period, 23 (22%) of 104 children (aged one month to 12 years) were diagnosed to have had perinatal stroke. The male:female ratio was 1.6:1. Ten (67%) of the 15 children who had unilateral ischemic involvement had their lesion in the left hemisphere. The presentation of the ischemic result was within 24-72 hours of life in 13 (57%) patients, and in 6 children (26%), motor impairment was recognized at or after the age of 4 months. Nine children (39%) had seizures at presentation. Pregnancy, labour, and delivery risk factors were ascertained in 18 (78%) cases. The most common of these included emergency cesarean section in 5 cases, and instrumental delivery in another 5. Screening for prothrombotic risk factors detected abnormalities in 6 (26%) patients on at least one test carried out between 2 months and 9 years of age. Four children (17%) had low protein C, which was associated with low protein S and raised anticardiolipin antibodies (ACA) in one patient, and low antithrombin III in another. Low protein S was detected in a 42-month-old boy. The abnormality in the sixth child was confined to raised ACA.
The present study highlights the non-specific features by which stroke presents during the neonatal period. The data are in keeping with the potential role for inherited and acquired thrombophilia as being the underlying cause. However, the high prevalence of additional acquired antenatal and perinatal risk factors support a multifactorial disorder.
前瞻性和回顾性描述沙特儿童围产期卒中的临床特征和表现，并确定危险因素。
从1992年7月至2001年2月（回顾性研究）以及2001年2月至2003年3月（前瞻性研究）在沙特阿拉伯利雅得沙特国王大学医学院哈立德国王大学医院儿科神经科接受评估的104名沙特儿童队列中识别出围产期卒中患者。对疑似卒中病例的神经影像学检查包括头颅CT、MRI或两者。
在研究期间，104名儿童（年龄1个月至12岁）中有23名（22%）被诊断患有围产期卒中。男女比例为1.6:1。15名单侧缺血性受累儿童中有10名（67%）病变位于左半球。13名（57%）患者的缺血性表现出现在出生后24至72小时内，6名儿童（26%）在4个月及以后出现运动障碍。9名儿童（39%）在就诊时出现癫痫发作。18例（78%）病例确定了妊娠、分娩和产时危险因素。其中最常见的包括5例急诊剖宫产和另外5例器械助产。对血栓形成前危险因素进行筛查，在2个月至9岁期间至少进行一项检查的6名（26%）患者中检测到异常。4名儿童（17%）蛋白C水平低，其中1例与蛋白S水平低和抗心磷脂抗体（ACA）升高有关，另1例与抗凝血酶III水平低有关。在一名42个月大的男孩中检测到蛋白S水平低。第六名儿童的异常仅限于ACA升高。
本研究突出了新生儿期卒中的非特异性特征。数据符合遗传性和获得性血栓形成倾向作为潜在病因的作用。然而，额外获得性产前和围产期危险因素的高患病率支持这是一种多因素疾病。
