Wang G M, Li Y B, Wei Q, Han Y W, Long H W, Liu X J
Department of Neurosurgery, First Hospital of Jilin University, Changchun 130021, China.
Department of Neurosurgery, Worker's Hospital of Liaoyuan Mineral System, Liaoyuan 136200, China.
Zhonghua Er Ke Za Zhi. 2019 Jan 2;57(1):46-49. doi: 10.3760/cma.j.issn.0578-1310.2019.01.011.
To investigate the clinical characteristics and risk-factors of traumatic basal ganglia stroke (TBGS) in children. A retrospective case study was conducted to analyze the clinical and imaging data of 16 children with TBGS in the First Hospital of Jilin University from January 2014 to June 2017. A total of 16 TBGS cases (11 males, 5 females) were diagnosed and the age ranged from 0.5 to 13.0 years. The prognosis of children with TBGS at different ages (≥5 years and<5 years) and with different traumatic stroke (infarction and hemorrhage) were compared. Fisher 's test was used to compare the prognosis of different groups. All cases had clear history of head trauma and varying degrees of limb paralysis after injury, including 4 cases of facial paralysis, 3 cases of consciousness disturbance and 1 case of seizures. Head CT scan of the 16 cases showed 11 cases of ischemic stroke and 5 cases of hemorrhagic stroke. Moreover, scattered calcification was observed in the bilateral basal ganglia point of 8 cases. Neurotrophic treatment, microcirculation improvement and nerve rehabilitations were given according to the clinical and imaging data. One patient was treated with craniotomy and hematoma clearance. Of the 16 cases, 11 cases were restored to normal, while 3 cases developed limb paralysis and 2 cases died. The prognosis of 11 cases of traumatic basal ganglia infarction (10 cases recovered and 1 case remained hemiplegic) was relatively better than that of 5 cases of hemorrhage (1 case recovered, 2 cases remained hemiplegic and 2 cases died) (χ(2)=8.045, 0.013). In addition, the children younger than 5-year-old (all 8 cases recovered) had a better prognosis than the children older than 5-year-old (8 cases, 3 of whom recovered, 3 cases remained hemiplegia, 2 cases died)(χ(2)=12.121, 0.01). The anatomical characteristics of basal ganglia and calcification of the lenticulostriate artery are risk-factors for TBGS in children. The prognosis of infarcted children and younger children is relatively better.
探讨儿童创伤性基底节区卒中（TBGS）的临床特征及危险因素。采用回顾性病例研究方法，分析吉林大学第一医院2014年1月至2017年6月收治的16例TBGS患儿的临床及影像学资料。共确诊16例TBGS病例（男11例，女5例），年龄0.5～13.0岁。比较不同年龄（≥5岁和<5岁）及不同创伤性卒中类型（梗死和出血）的TBGS患儿的预后。采用Fisher检验比较不同组别的预后。所有病例均有明确的头部外伤史，伤后出现不同程度的肢体瘫痪，其中面瘫4例，意识障碍3例，癫痫发作1例。16例患儿头部CT扫描显示缺血性卒中11例，出血性卒中5例。此外，8例双侧基底节区可见散在钙化。根据临床及影像学资料给予神经营养治疗、改善微循环及神经康复治疗。1例患者行开颅血肿清除术。16例中，11例恢复正常，3例遗留肢体瘫痪，2例死亡。11例创伤性基底节梗死患者的预后（10例恢复，1例遗留偏瘫）相对优于5例出血患者（1例恢复，2例遗留偏瘫，2例死亡）（χ²=8.045，P=0.013）。此外，5岁以下儿童（8例均恢复）的预后优于5岁以上儿童（8例，3例恢复，3例遗留偏瘫，2例死亡）（χ²=12.121，P=0.01）。基底节的解剖学特征及豆纹动脉钙化是儿童TBGS的危险因素。梗死患儿及年龄较小患儿的预后相对较好。
