Powell F C, Hanigan W C, McCluney K W
Department of Neurological Surgery, University of Illinois College of Medicine at Peoria.
Stroke. 1994 Jan;25(1):117-21. doi: 10.1161/01.str.25.1.117.
This report examines the occurrence of subcortical infarction in 5 children, reviews the English literature, and discusses evaluation of this uncommon childhood illness.
Clinical characteristics and neurological follow-up were examined in children who presented with subcortical infarction within the past 7 years. The English literature over the previous 20 years was reviewed to identify similar patients with radiological documentation of subcortical infarction.
Mean age of the patients in this series was 4.8 years (range, 4 months to 12 years); 3 children were female. Three patients presented with the sudden onset of hemiparesis, 1 with dystonia, and 1 with fever and focal seizures. Protein C deficiencies were demonstrated in 2 children; a cardiomyopathy was seen in 1 patient. Mean follow-up was 1.5 years. Two patients were neurologically normal, mild residual symptoms persisted in 2, and 1 patient showed severe dystonia. The literature analysis indicated that specific risk factors were described in 79 patients; complete clinical analysis was available for 51 patients. In the latter group, the mean age was 5.7 years; 26 children were female. Forty-six presented with hemiplegia, 4 with dystonia, and 1 with focal seizures. Follow-up greater than 5 months in 29 patients showed complete or good resolution of deficits in 23. Specific risk factors such as infection, trauma, hematologic disorders, or cardiac or vascular abnormalities were identified in 62 of 79 children.
This analysis indicates that children with subcortical infarction usually presented with acute hemiparesis. Risk factors were identified in the majority of children, and follow-up demonstrated good or complete resolution of neurological deficits in 80% of the patients.
本报告研究了5例儿童皮质下梗死的发生情况，回顾了英文文献，并讨论了对这种罕见儿童疾病的评估。
对过去7年内出现皮质下梗死的儿童的临床特征和神经学随访情况进行了检查。回顾了过去20年的英文文献，以确定有皮质下梗死放射学记录的类似患者。
本系列患者的平均年龄为4.8岁（范围为4个月至12岁）；3名儿童为女性。3例患者突然出现偏瘫，1例出现肌张力障碍，1例出现发热和局灶性癫痫发作。2名儿童被证实存在蛋白C缺乏；1例患者患有心肌病。平均随访时间为1.5年。2例患者神经学正常，2例仍有轻度残留症状，1例患者表现为严重肌张力障碍。文献分析表明，79例患者描述了特定危险因素；51例患者有完整的临床分析。在后一组中，平均年龄为5.7岁；26名儿童为女性。46例表现为偏瘫，4例表现为肌张力障碍，1例表现为局灶性癫痫发作。29例随访超过5个月的患者中，23例的缺损完全或良好恢复。79名儿童中有62名确定了特定危险因素，如感染、创伤、血液系统疾病或心脏或血管异常。
该分析表明，皮质下梗死患儿通常表现为急性偏瘫。大多数儿童确定了危险因素，随访显示80%的患者神经功能缺损得到良好或完全恢复。
