Fidan Emin, Cummings Dana D, Manole Mioara D
From the Divisions of Pediatric Critical Care Medicine.
Child Neurology, and.
Pediatr Emerg Care. 2018 Dec;34(12):e233-e235. doi: 10.1097/PEC.0000000000001229.
Cerebral infarction due to minor head injury is rare. Mineralizing angiopathy is considered a predisposing factor for lenticulostriate stroke after minor closed head injury. This entity is characterized by infarction of the basal ganglia and most often occurs in young children, from infancy to 2 years of age. Symptoms usually occur immediately after the injury.
We present the case of a previously healthy 2-year-old female child presenting with right facial hemiparesis and aphasia, along with right arm and leg weakness that occurred immediately after a fall from the couch onto a carpeted floor. A brain computed tomography scan revealed small and linear calcifications of the basal ganglia and subcortical frontoparietal area, in the absence of signs of intracranial hemorrhage. Brain magnetic resonance imaging with stroke protocol revealed restriction of water diffusion in the left basal ganglia on diffusion-weighted imaging sequences as well as apparent diffusion coefficient sequences, suggesting an acute infarct of the left basal ganglia within the distribution of the lenticulostriate vessels. The patient was treated with aspirin and conservative management and had gradual improvement over the next few days, with full recovery of the aphasia, facial nerve function, and arm and leg mobility, within 2 months.
Some infants can present with the onset of stroke-like symptoms after minor head injuries. Presence of linear calcifications of the basal ganglia noticed on brain computed tomography in many of these patients suggests that mineralizing angiopathy may be a predisposing factor for lenticulostriate stroke after minor closed head injury in infants. Brain magnetic resonance imaging to further delineate possible cerebral infarction is indicated.
轻度头部损伤所致脑梗死较为罕见。矿化性血管病被认为是轻度闭合性头部损伤后豆纹状动脉卒中的一个易感因素。该病症以基底节梗死为特征，最常发生于婴儿期至2岁的幼儿。症状通常在损伤后立即出现。
我们报告一例既往健康的2岁女童病例，她从沙发跌落到铺有地毯的地板后立即出现右侧面部偏瘫、失语，以及右臂和右腿无力。脑部计算机断层扫描显示基底节和皮质下额顶叶区域有小的线性钙化，无颅内出血迹象。采用卒中方案的脑部磁共振成像在扩散加权成像序列以及表观扩散系数序列上显示左侧基底节水扩散受限，提示豆纹状动脉分布区内左侧基底节急性梗死。该患者接受了阿司匹林治疗和保守处理，在接下来的几天里逐渐好转，2个月内失语、面神经功能以及手臂和腿部活动能力完全恢复。
一些婴儿在轻度头部损伤后可出现类似中风的症状。许多此类患者脑部计算机断层扫描显示基底节有线性钙化，这表明矿化性血管病可能是婴儿轻度闭合性头部损伤后豆纹状动脉卒中的一个易感因素。需要进行脑部磁共振成像以进一步明确是否存在脑梗死。
