Souto Silva Renata, Rodrigues Rita, Reis Monteiro Diana, Tavares Susana, Pereira José Pedro, Xavier João, Melo Cláudia, Ruano Luís
Neurology Department, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, Portugal.
Pediatrics Department, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, Portugal.
Case Rep Neurol. 2019 Feb 8;11(1):47-52. doi: 10.1159/000496535. eCollection 2019 Jan-Apr.
Acute ischemic stroke in the pediatric population is rare but carries lasting and often lifelong morbidity. Thrombolysis and mechanical thrombectomy are mainstays of care in adults, yet there is very little evidence for these treatments in children. We present the case of a 4-year-old boy with complex congenital heart disease, admitted 30 min after sudden onset of an aphasia and right hemiplegia, scoring 14 on the Pediatric National Institutes of Health Stroke Scale (PedNIHSS). Non-contrast brain computed tomography (CT) showed no evidence of acute ischemia. CT angiogram demonstrated a thrombus in the M1 segment of the left middle cerebral artery. Intravenous recombinant tissue plasminogen activator (rTPA) was infused 3.5 h after onset of symptoms. An improvement was observed in the hour after rTPA, with a PedNIHSS score of 7. Digital subtraction angiography was performed approximately 9 h from the onset of symptoms, showing a complete left M1 occlusion. The patient underwent successful mechanical thrombectomy and was discharged with a PedNIHSS score of 2. This case emphasizes the importance of early recognition to direct children towards rapid diagnosis and hyperacute treatment.
小儿急性缺血性卒中虽罕见，但会导致持久且往往伴随终生的发病情况。溶栓和机械取栓是成人治疗的主要手段，但在儿童中，这些治疗方法的证据非常少。我们报告一例患有复杂先天性心脏病的4岁男孩，在突发失语和右侧偏瘫30分钟后入院，小儿国立卫生研究院卒中量表（PedNIHSS）评分为14分。非增强脑部计算机断层扫描（CT）未显示急性缺血迹象。CT血管造影显示左侧大脑中动脉M1段有血栓形成。症状发作3.5小时后静脉注射重组组织型纤溶酶原激活剂（rTPA）。注射rTPA后一小时观察到病情改善，PedNIHSS评分为7分。症状发作约9小时后进行数字减影血管造影，显示左侧M1段完全闭塞。患者成功接受了机械取栓治疗，出院时PedNIHSS评分为2分。该病例强调了早期识别对于指导儿童进行快速诊断和超急性治疗的重要性。
