Yoshida S, Yamamoto T, Yoshioka M, Kuroki S
Department of Neurosurgery, Kobe City General Hospital, Japan.
No Shinkei Geka. 1993 Jul;21(7):611-6.
We have encountered 38 cases of juvenile ischemic strokes during the past 10 years, which included 16 cases of moyamoya disease and 22 cases of non-moyamoya strokes. The etiology could not be determined in most non-moyamoya strokes, except in 4 cases of cardiogenic embolism and 1 case of post-meningitic stroke. We further examined 13 cases of idiopathic strokes, which showed clinical symptoms of so-called acute infantile hemiplegia. Nine out of 13 patients developed strokes between 6 months and 2 years of age. Strong male preponderance was noted, since 11 out of 13 patients were boys. CT scan showed basal ganglionic infarction in the territory of the perforating branches of the middle cerebral artery in 12 patients. Recurrence of ischemic events occurred in none of the patients during the mean follow-up period of 48.4 months. Functional recovery was also good, since no neurological sequelae were found in 5 patients, and the other 8 disabled children were able to go to school without help and none of the children were mentally retarded. These results and a review of the literature suggest the importance of traumatic mechanisms in the etiology and pathogenesis of juvenile idiopathic ischemic strokes of the acute infantile hemiplegic type.
在过去10年中，我们共收治了38例青少年缺血性卒中患者，其中包括16例烟雾病患者和22例非烟雾病性卒中患者。除4例心源性栓塞和1例脑膜炎后卒中外，大多数非烟雾病性卒中的病因无法确定。我们进一步检查了13例特发性卒中患者，这些患者表现出所谓的急性婴儿偏瘫的临床症状。13例患者中有9例在6个月至2岁之间发生卒中。男性明显居多，因为13例患者中有11例为男孩。CT扫描显示，12例患者大脑中动脉穿支供血区域的基底节梗死。在平均48.4个月的随访期内，所有患者均未发生缺血事件复发。功能恢复也很好，因为5例患者未发现神经后遗症，其他8例残疾儿童能够在无需帮助的情况下上学，且所有儿童均无智力障碍。这些结果以及文献回顾表明，创伤机制在急性婴儿偏瘫型青少年特发性缺血性卒中的病因和发病机制中具有重要意义。
