Nabika S, Kiya K, Satoh H, Mizoue T, Oshita J, Kondo H
Department of Neurosurgery, Hiroshima Prefectural Hospital, Hiroshima, Japan.
Pediatr Neurosurg. 2007;43(4):312-5. doi: 10.1159/000103313.
We encountered an instructive case of repetitive reversible severe neurological deficit due to ischemia of the internal capsule after mild head injury. A 1-year-old boy fell and hit his head on the floor without losing consciousness. Intermittent episodes of left hemiparesis lasting from 30 s to 30 min developed 4 h later. Magnetic resonance (MR) imaging revealed acute infarction in the left internal capsule and corona radiata on diffusion-weighted imaging, and no microbleeding on susceptibility-weighted imaging. MR angiography of the intracranial and cervical vessels showed no obstruction of the large cerebral arteries. Motor impairment began to improve the next day with conservative therapy. Neurological deficit gradually resolved over the course of 1 month. This tiny lesion of the internal capsule and corona radiata may have represented a small infarction caused by mechanical vasospasm of the perforating vessels branching from the middle cerebral artery after minor injury. Even mild head injuries may cause infarction of the internal capsule, although minor head injuries are common accidents in childhood and usually do not result in severe complications.
我们遇到了一例因轻度头部损伤后内囊缺血导致反复可逆性严重神经功能缺损的典型病例。一名1岁男孩摔倒，头部撞到地板，但未失去意识。4小时后出现持续30秒至30分钟的间歇性左侧偏瘫发作。磁共振（MR）成像在扩散加权成像上显示左侧内囊和放射冠急性梗死，在磁敏感加权成像上未显示微出血。颅内和颈部血管的MR血管造影显示大脑大动脉无阻塞。经保守治疗，运动障碍于次日开始改善。神经功能缺损在1个月内逐渐消退。内囊和放射冠的这个微小病变可能代表了轻微损伤后大脑中动脉分支的穿支血管机械性血管痉挛引起的小梗死。即使是轻度头部损伤也可能导致内囊梗死，尽管轻度头部损伤在儿童期是常见事故，通常不会导致严重并发症。
