摘要
目的探讨儿童脑梗死的病因、临床表现和磁共振成像(MRI)特点。方法回顾性分析山西省儿童医院2016年1月-2019年11月间经临床及MRI检查确诊为脑梗死的41例患儿的临床及磁共振成像资料。所有患者均行颅脑MRI检查。结果病因明确28例;病因不明确13例。性别、年龄与病因之间均无相关关系(P>0.05)。临床表现为肢体无力活动障碍、口角歪斜、鼻唇沟浅或消失、抽搐、流涎、口齿不清及饮水呛咳;MR表现:病变部位:外伤以基底节、侧脑室旁为主;烟雾病累及多脑叶为主;感染以基底节最多见;甲亢累及单侧基底节、半卵圆中心及放射冠;先天性心脏病术后累及单侧多脑叶和大脑脚;病因不明确者以累及基底节(11/13)最多见;各病因在脑叶、胼胝体受累差异有统计学意义(P<0.05),余病变部位差异无统计学意义(P>0.05)。MRI信号特点:39例显示为稍长T1稍长T2信号,FLAIR序列呈稍高或高信号,DWI显示为明显高信号,ADC图呈低信号;29例行MRA成像,其中18例均出现不同程度脑供血动脉的狭窄或闭塞,大脑中动脉受累最多见;各病因在大脑中动脉受累、多发迂曲血管影及双侧受累差异有统计学意义(P<0.05);行DTI扫描8例,发现脑白质纤维束受损6例,未受损2例;随访17例,随访间隔时间最短8 d,最长2年6个月,发现新发梗死2例,余均呈脑梗后遗改变。结论引起儿童脑梗死的病因多样,以外伤、烟雾病最常见,明确病因对于指导临床及时治疗及促进预后有重要意义。临床表现以肢体活动障碍最多见。病变部位以基底节区受累最多见,但不同病因病变部位无明显差异。其MR表现具有特征性,血管受累以大脑中动脉最多见;DTI可无创性观察脑白质纤维束破坏程度,因此MR可作为儿童脑梗死的首选影像学检查。
Objective To explore the etiology,clinical manifestations and Magnetic resonance image(MRI)features of cerebral infarction in children.Methods The clinical and imaging data of 41 children with cerebral infarction confirmed by clinical and MRI examination from January 2016 to November 2019 in Shanxi children’s hospital were analyzed retrospectively.Results The etiology was clear in 28 cases;the etiology was not clear in 13 cases.There was no correlation between gender,age group and etiology(P>0.05).The clinical manifestations are limb weakness,movement disorder,skew mouth,shallow or disappearing nasolabial groove,convulsion,salivation,slurred speech,and coughing with drinking water;MRI findings:lesion location:trauma mainly involved basal ganglia and paraventricular;multiple lobes were involved in moyamoya disease,and basal ganglia was the most common site of infection;hyperthyroidism involved unilateral basal ganglia,semicircular center and corona radiata;congenital heart disease involved unilateral multiple lobes and cerebral feet;the most common case of unclear etiology involved basal ganglia.There was significant difference in the involvement of cerebral lobes and corpus callosum(P<0.05).There was no significant difference in other lesions(P>0.05).MRI signal features:39 cases showed slightly longer T1 and slightly longer T2 signal,FLAIR sequence showed slightly higher or higher signal,DWI showed significantly higher signal,ADC showed low signal;MRA imaging was performed in 29 cases,of which 18 cases had stenosis or occlusion of cerebral blood supply artery in different degrees,and the middle cerebral artery was most affected;there were significant differences among the causes of middle cerebral artery involvement,multiple tortuous vascular shadows and bilateral involvement(P<0.05).DTI scan showed that 6 cases of white matter fiber bundle were found damaged,2 cases were not damaged;17 cases were followed up,with the shortest interval of 8 days and the longest interval of 2 years and 6 months.2 cases of new in
作者
白娟
徐树明
BAI Juan;XU Shu-Ming(Department of Medical Imaging,Shanxi Medical University,Taiyuan,Shanxi 030001,China)
出处
《中国妇幼保健》
CAS
2021年第17期3970-3975,共6页
Maternal and Child Health Care of China
基金
山西省留学回国人员科技活动项目择优资助项目([2011]762号)
山西省儿童医院、山西省妇幼保健院科研课题立项项目(201947)。
关键词
儿童
脑梗死
病因
磁共振成像
Children
Cerebral infarction
Etiology
Magnetic resonance image
