From the Department of Neurology (M.T.M.) and Emergency Department (Z.K.C., M.L., F.E.B.), Royal Children's Hospital Melbourne, Parkville; Murdoch Childrens Research Institute (M.T.M., F.E.B.), Parkville; Florey Institute of Neurosciences and Mental Health (M.T.M., L.C., G.A.D.), Parkville; University of Melbourne (M.T.M., Z.K.C., M.L., L.C., P.M., G.A.D., F.E.B.), Parkville, Australia; and Hospital Nacional de Ninos (A.Y.-C.), San Jose, Costa Rica.
Neurology. 2014 Apr 22;82(16):1434-40. doi: 10.1212/WNL.0000000000000343. Epub 2014 Mar 21.
To determine symptoms, signs, and etiology of brain attacks in children presenting to the emergency department (ED) as a first step for developing a pediatric brain attack pathway.
Prospective observational study of children aged 1 month to 18 years with brain attacks (defined as apparently abrupt-onset focal brain dysfunction) and ongoing symptoms or signs on arrival to the ED. Exclusion criteria included epilepsy, hydrocephalus, head trauma, and isolated headache. Etiology was determined after review of clinical data, neuroimaging, and other investigations. A random-effects meta-analysis of similar adult studies was compared with the current study.
There were 287 children (46% male) with 301 presentations over 17 months. Thirty-five percent arrived by ambulance. Median symptom duration before arrival was 6 hours (interquartile range 2-28 hours). Median time from triage to medical assessment was 22 minutes (interquartile range 6-55 minutes). Common symptoms included headache (56%), vomiting (36%), focal weakness (35%), numbness (24%), visual disturbance (23%), seizures (21%), and altered consciousness (21%). Common signs included focal weakness (31%), numbness (13%), ataxia (10%), or speech disturbance (8%). Neuroimaging included CT imaging (30%), which was abnormal in 27%, and MRI (31%), which was abnormal in 62%. The most common diagnoses included migraine (28%), seizures (15%), Bell palsy (10%), stroke (7%), and conversion disorders (6%). Relative proportions of conditions in children significantly differed from adults for stroke, migraine, seizures, and conversion disorders.
Brain attack etiologies differ from adults, with stroke being the fourth most common diagnosis. These findings will inform development of ED clinical pathways for pediatric brain attacks.
确定以急症室（ED）首诊为首发表现的儿童脑卒中的症状、体征和病因，为制定儿科脑卒中通路奠定基础。
对年龄在 1 个月至 18 岁之间、具有脑卒中（定义为突发局灶性脑功能障碍）且到达 ED 时仍有持续症状或体征的患儿进行前瞻性观察性研究。排除标准包括癫痫、脑积水、头部创伤和孤立性头痛。病因通过对临床资料、神经影像学和其他检查的回顾性评估来确定。对类似的成人研究进行随机效应荟萃分析，并与本研究进行比较。
在 17 个月内共有 287 名（46%为男性）患儿，共 301 例就诊，其中 35%是通过救护车送来的。到达前的中位症状持续时间为 6 小时（四分位间距 2-28 小时）。从分诊到医疗评估的中位时间为 22 分钟（四分位间距 6-55 分钟）。常见症状包括头痛（56%）、呕吐（36%）、局灶性无力（35%）、麻木（24%）、视力障碍（23%）、癫痫发作（21%）和意识改变（21%）。常见体征包括局灶性无力（31%）、麻木（13%）、共济失调（10%）或言语障碍（8%）。神经影像学包括 CT 成像（30%），其中 27%异常，MRI（31%），其中 62%异常。最常见的诊断包括偏头痛（28%）、癫痫发作（15%）、贝尔面瘫（10%）、脑卒中（7%）和转换障碍（6%）。儿童的疾病情况与成人相比，脑卒中、偏头痛、癫痫发作和转换障碍的比例显著不同。
儿童脑卒中的病因与成人不同，脑卒中是第四大常见诊断。这些发现将为儿科脑卒中的 ED 临床通路的制定提供信息。
