Division of Pediatric Neurology, Department of Pediatrics, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
J Formos Med Assoc. 2010 Feb;109(2):156-62. doi: 10.1016/S0929-6646(10)60036-8.
BACKGROUND/PURPOSE: To describe the clinical characteristics and imaging findings of craniocervical dissection in childhood ischemic stroke, in a tertiary medical center.
In this retrospective study, we investigated children (aged 1 month to 18 years) with symptoms and radiographic confirmation of ischemic stroke from January 1996 to January 2007. Stroke work-up included neuroimaging (magnetic resonance imaging, computed tomography, conventional angiography, and magnetic resonance angiography), cardiac assessment, prothrombotic assays, immunoassays, infection screening, and metabolic screening.
Among 95 children with arterial ischemic stroke, arterial dissection was identified as the underlying risk factor in nine patients (7 boys and 2 girls; age range, 1.9 17.2 years). All the patients had focal neurological signs and two had warning symptoms. A history of trauma was noted in two patients and another two had stroke during physical exertion. The other five patients had spontaneous dissection. Six patients had anterior circulation arterial dissection. Three patients had posterior circulation arterial dissection, and the most common location was in the vertebral artery. Antiplatelet treatment was given to five patients and anticoagulants to one. Endovascular treatment was given to one patient with dissecting aneurysm. One patient died at the acute stage and another seven had neurological deficits after 9 months to 8 years follow-up. The ninth patient had no residual neurological impairment. No patients had recurrent stroke.
Arterial dissection should be considered in childhood ischemic stroke. Spontaneous arterial dissection is an important factor in this group. Early investigation and treatment can improve the outcome.
背景/目的：描述在一家三级医疗中心中，儿童缺血性脑卒中颅颈血管夹层的临床特征和影像学表现。
在这项回顾性研究中，我们调查了 1996 年 1 月至 2007 年 1 月期间因症状和影像学证实为缺血性脑卒中而就诊的儿童（年龄 1 个月至 18 岁）。脑卒中的检查包括神经影像学（磁共振成像、计算机断层扫描、常规血管造影和磁共振血管造影）、心脏评估、血栓前状态检查、免疫检查、感染筛查和代谢筛查。
在 95 例动脉性缺血性脑卒中患儿中，9 例（7 名男孩和 2 名女孩；年龄 1.9 17.2 岁）患者的潜在风险因素为动脉夹层。所有患者均有局灶性神经体征，2 例有预警症状。2 例患者有创伤史，另有 2 例患者在体力活动中发生脑卒中。另外 5 例患者为自发性夹层。6 例患者为前循环动脉夹层，3 例患者为后循环动脉夹层，最常见的部位是椎动脉。5 例患者接受抗血小板治疗，1 例患者接受抗凝治疗。1 例夹层动脉瘤患者接受了血管内治疗。1 例患者在急性期死亡，另 7 例患者在 9 个月至 8 年的随访中存在神经功能缺损。第 9 例患者无残留神经功能障碍。无患者复发脑卒中。
儿童缺血性脑卒中时应考虑动脉夹层。自发性动脉夹层是该组患者的一个重要因素。早期的检查和治疗可以改善预后。
