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目的了解新生儿卒中(neonatal stroke,NS)的临床特点,提高对NS的认识,减少漏诊或误诊。方法对37例NS的临床资料进行回顾性调查分析,记录各种围生期因素、临床表现和影像学检查结果。结果 1)37例患儿中31例(83.8%)有神经系统症状体征,其中24例(77.4%)以惊厥为首发症状或主要表现,15例(62.5%)有定位意义。10例(32.3%)原始反射减弱。6例(16.2%)患儿无明显神经系统异常表现,而在头颅影像学检查时发现脑梗死改变;2)发病时间最短生后10min,最长12d。其中在生后24h内发病者23例(74.2%),48h内发病者27例(87.1%),72h内发病28例(90.3%);3)剖宫产分娩26例(70.3%),自然分娩11例(29.7%);4)围生期缺氧史16例(43.2%),胎膜早破和宫内感染10例(27.0%);5)双侧大脑半球同时受累18例(48.6%),左侧大脑半球受累12例(32.4%),右侧大脑半球与基底节受累各7例(18.9%)。结论惊厥是NS最常见临床表现,且常为首发症状;发病早;剖宫产分娩者占70%以上;围生期缺氧、宫内感染与新生儿NS密切相关,为其重要高危因素;常为双侧大脑半球同时受累,单侧大脑半球梗死左侧多于右侧,近20%的患儿同时合并有基底节梗死;60%以上患儿预后不良;确诊有赖于影像学检查,首选颅脑B超,进一步确诊可作MRI-DWI。
Objective To understand the clinical features of neonatal stroke (NS), to improve the understanding of NS and to reduce misdiagnosis and missed diagnosis. Methods The clinical data of 37 NS patients were retrospectively analyzed and recorded. Various perinatal factors, clinical manifestations and imaging findings were recorded. Results 1) Thirty-seven children (83.8%) had neurological symptoms and signs. Among them, 24 (77.4%) had seizures as the first symptom or main symptom, and 15 (62.5%) had localization significance. Ten cases (32.3%) of the original reflex decreased. Six patients (16.2%) had no obvious neurological abnormalities, while cerebral infarction was found on cranial imaging examination. 2) The shortest onset time was 10 minutes after birth and the longest was 12 days. Among them, 23 cases (74.2%) developed disease within 24 hours after birth, 27 cases (87.1%) developed disease within 48 hours and 28 cases (90.3%) developed disease within 72 hours. 26 cases (70.3% 11 cases of childbirth (29.7%); 4) 16 cases of perinatal hypoxia (43.2%), premature rupture of membranes and intrauterine infection in 10 cases (27.0%); %), Left hemisphere involvement in 12 cases (32.4%), right hemisphere and basal ganglia involvement in 7 cases (18.9%). Conclusions Convulsion is the most common clinical manifestations of NS, and often the first symptom; early onset; cesarean section delivery accounted for more than 70%; perinatal hypoxia, intrauterine infection and neonatal NS are closely linked to its important risk factors; Often bilateral brain hemisphere affected at the same time, unilateral cerebral hemispheric infarction left more than the right, nearly 20% of children with basal ganglia infarction; more than 60% of children with poor prognosis; diagnosis depends on the imaging examination, the preferred Brain B ultrasound, further diagnosis can be used for MRI-DWI.