Stroke Imaging Lab for Children, Department of Translational Medicine, The Hospital for Sick Children, Peter Gilgan Centre for Research & Learning, Toronto, Ontario, Canada; Stroke Imaging Lab for Children, Department of Child Health & Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research & Learning, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.
Pediatrics, University of Toronto, Toronto, Ontario, Canada; Children's Stroke Program, Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada; Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada.
Pediatr Neurol. 2020 Jan;102:67-73. doi: 10.1016/j.pediatrneurol.2019.07.004. Epub 2019 Jul 31.
To evaluate the presence of Wallerian degeneration and its relationship with sensorimotor deficits following childhood-onset arterial ischemic stroke (AIS).
Children surviving unilateral AIS older than one month of age were assessed for severity of sensorimotor neurological deficit with the Pediatric Stroke Outcome Measure at least one year post stroke (mean follow-up = 2.9 years, S.D. = ±1.6). The area (mm) of each cerebral peduncle was measured on T2-weighted magnetic resonance images to calculate an Asymmetry Index (AI). The AI between patients with childhood stroke (cases) and controls (children with normal MRI) was compared. In the stroke group, the AI between patients with good and poor motor outcome, and the correlation between the AI and motor outcome was calculated.
Asymmetry was compared in 52 children with stroke (cases) and 20 controls (normal brain MRIs). The AI was greater in patients with stroke (mean = 6.8%, S.D. = ±5.9) compared with controls (mean = 3.4%, S.D. = ±3.5, P < 0.02). Patients with poor outcome had an AI of 10% or greater compared with patients with good outcome (mean 10.4 versus 4, P < 0.001), and the AI was moderately correlated with motor deficit severity (r = 0.582, P = 0.001).
Asymmetry of the cerebral peduncle is a feasible method of assessing Wallerian degeneration in children with unilateral AIS. The degree of asymmetry in the cerebral peduncles was moderately correlated with neurological outcome severity and reflects the degree of motor deficit in children following stroke.
评估儿童期起病的动脉缺血性中风（AIS）后 Wallerian 变性的存在及其与感觉运动功能障碍的关系。
对年龄大于 1 个月且存活的单侧 AIS 患儿，在中风后至少 1 年（平均随访时间为 2.9 年，标准差为±1.6）使用小儿中风评估量表（Pediatric Stroke Outcome Measure）评估感觉运动神经功能缺损的严重程度。在 T2 加权磁共振图像上测量每个大脑脚的面积（mm），以计算不对称指数（Asymmetry Index，AI）。将患儿中风组（病例）和对照组（MRI 正常的儿童）的 AI 进行比较。在中风组中，计算 AI 在运动预后良好和预后不良的患者之间的差异，并计算 AI 与运动预后之间的相关性。
比较了 52 例中风患儿（病例）和 20 例对照组（MRI 正常）的不对称性。与对照组（mean=3.4%，SD=±3.5，P<0.02）相比，中风患儿的 AI 更大（mean=6.8%，SD=±5.9）。运动预后不良的患者的 AI 为 10%或更高，与运动预后良好的患者相比（mean 10.4 与 4，P<0.001），AI 与运动缺陷严重程度中度相关（r=0.582，P=0.001）。
大脑脚的不对称是评估单侧 AIS 儿童 Wallerian 变性的可行方法。大脑脚的不对称程度与神经功能预后严重程度中度相关，反映了儿童中风后运动缺陷的程度。
