Department of Neurosurgery, Hachioji Medical Center, Tokyo Medical University, Japan.
J Stroke Cerebrovasc Dis. 2010 Jan;19(1):77-80. doi: 10.1016/j.jstrokecerebrovasdis.2009.04.001.
Cerebellar infarction of childhood is rare, and is difficult in pathological diagnosis. We describe a case of radiographically diagnosed primary central nervous system angiitis of childhood.
A 7-year-old boy experienced dizziness and headache persisting for 7 days. Diffusion-weighted images of magnetic resonance (MR) showed high signals in the left cerebellar hemisphere and vermis. The MR angiogram (MRA) findings were normal. A conventional angiogram demonstrated severe stenoses and occlusions at distal portion of left posterior inferior cerebellar artery, and irregularity in the wall of the cervical portion of the left vertebral artery (VA). Although he recovered without any neurologic deficits, an angiogram 3 months after admission showed occlusion at the cervical portion of left VA and filling of the distal VA with collateral arteries from the deep cervical artery. He was doing well, with no additional changes demonstrated on MRA, 12 months after the onset.
Although MRA can detect abnormality within the proximal intracranial vessels, angiography is essential, especially in cases with distal stenoses. Repeated angiography in primary central nervous system angiitis of childhood is necessary at least 3 months after the onset, even if the patient has no symptom.
儿童小脑梗死罕见，病理诊断困难。我们描述了一例经影像学诊断的儿童原发性中枢神经系统血管炎。
1 例 7 岁男孩，头晕头痛 7 天。磁共振弥散加权成像（MR）显示左小脑半球和蚓部高信号。磁共振血管造影（MRA）正常。常规血管造影显示左侧小脑后下动脉远端严重狭窄和闭塞，左侧椎动脉（VA）颈段管壁不规则。尽管他没有任何神经功能缺损而恢复，但入院 3 个月后的血管造影显示左侧 VA 颈段闭塞，远端 VA 由来自深部颈动脉的侧支填充。发病 12 个月后，MRA 未见进一步异常，他情况良好。
尽管 MRA 可以检测到颅内近端血管的异常，但血管造影是必要的，尤其是在存在远端狭窄的情况下。儿童原发性中枢神经系统血管炎至少在发病后 3 个月需要重复血管造影，即使患者无症状。
