McKasson Marilyn J, Golomb Meredith R
Division of Pediatric Neurology, Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA.
J Child Neurol. 2011 Dec;26(12):1548-54. doi: 10.1177/0883073811413277. Epub 2011 Aug 23.
It is rare for both limb ischemia and arterial ischemic stroke to occur in the same child during the perinatal period. Two children who appear to have had perinatal emboli to both an arm and a middle cerebral artery territory are presented here. One child required amputation of the ischemic limb below the shoulder, and the other required skin grafts to the distal ischemic fingers. Each of these children later received cerebral magnetic resonance imaging for evaluation of developmental delay and was found to have what appeared to be old perinatal arterial ischemic stroke. Both children were homozygous for the methylenetetrahydrofolate reductase C677T gene variant. Eight other children with perinatal limb ischemia and stroke were found on literature review; several also had delayed diagnosis of perinatal stroke. This report examines the approach to diagnosis and treatment in each of these and makes suggestions for the similar cases in the future.
围产期同一儿童同时发生肢体缺血和动脉缺血性卒中的情况较为罕见。本文介绍了两名似乎在围产期手臂和大脑中动脉区域均发生栓子的儿童。一名儿童需要在肩部以下截肢缺血肢体，另一名儿童需要对远端缺血手指进行皮肤移植。这两名儿童后来均接受了脑磁共振成像检查以评估发育迟缓情况，结果发现均存在似乎为陈旧性围产期动脉缺血性卒中的病变。两名儿童均为亚甲基四氢叶酸还原酶C677T基因变异的纯合子。通过文献回顾发现另外八名患有围产期肢体缺血和卒中的儿童；其中几名围产期卒中的诊断也有所延迟。本报告探讨了对这些患儿的诊断和治疗方法，并对未来类似病例提出了建议。
