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目的总结儿童缺血性脑血管病(ICD)的临床特点与病因。方法采用自行设计的儿童ICD调查表,包括发病年龄、性别、个人史、临床表现、脑脊液检查、神经影像学检查、免疫检查、代谢检查等,对武汉市儿童医院神经内科2002年2月-2008年6月住院的53例ICD患儿病例资料进行回顾性分析。结果53例患儿中,男30例(56.6%),女23例(43.4%);起病年龄为9个月～12岁,其中≤6岁45例(84.9%);患儿分布农村(60.4%)多于城市(39.6%);全年均有发病。53例ICD患儿的首发神经功能障碍中,40例(75.5%)为肢体瘫痪,其中偏瘫32例(60.4%),交替性偏瘫5例(9.4%),单肢瘫3例(5.7%)。颅脑CT/MRI检查显示基底核区缺血病灶27例(50.9%),其次为多脑叶梗死15例(28.3%);磁共振脑血管成像/数字减影血管造影术显示40例血管影像异常,其中大脑中动脉及其分支受累者最多[21例(52.5%)]。41例(77.4%)明确病因,以感染[13例(24.5%)]最多,其次为烟雾病8例(15.1%)、脑血管畸形5例(9.4%)、头部外伤4例(7.5%);12例(22.6%)病因不明。结论儿童ICD多以肢体瘫痪为首发症状,最常受累的病变部位为大脑中动脉及其分支,其次为颈内动脉、大脑前动脉、大脑后动脉、脑血管畸形等。其发病原因以感染最多见,其次为烟雾病、脑血管畸形和头部外伤等,还有一部分原因不明。
Objective To summarize the clinical features and causes of childhood ischemic cerebrovascular disease (ICD). Methods A self-designed ICD questionnaire for children, including age of onset, sex, personal history, clinical manifestations, cerebrospinal fluid examination, neuroimaging, immunoassay and metabolic examination, was performed on the neurology department of Wuhan Children’s Hospital from February 2002 to 2008 Data of 53 ICD children hospitalized in June were retrospectively analyzed. Results Among the 53 children, 30 (56.6%) were males and 23 (43.4%) were females. The age of onset was 9 months to 12 years, of which 45 (84.9%) were ≤6 years old. 60.4%) than in the city (39.6%); Of the 53 children with ICD, 40 (75.5%) had limb paralysis, of which 32 (60.4%) had hemiplegia, 5 (9.4%) had alternating hemiplegia and 3 (5.7%) had unilateral limb palsy . Brain CT / MRI showed 27 cases (50.9%) of ischemic lesions in the basal ganglia area, followed by 15 cases (28.3%) of multiple cerebral infarction. Magnetic resonance angiography and digital subtraction angiography showed 40 cases of vascular images Abnormal, including the middle cerebral artery and its branches affected most [21 cases (52.5%)]. Thirty-one cases (77.4%) had a clear cause of infection, with 13 cases (24.5%) having the most infection, followed by 8 cases with moyamoya disease (15.1%), 5 cases with cerebrovascular malformations (9.4% ); Etiology of 12 patients (22.6%) was unknown. Conclusion Most children with limb paralysis as the first symptom, the most common lesion is the middle cerebral artery and its branches, followed by the internal carotid artery, anterior cerebral artery, posterior cerebral artery, cerebral vascular malformations. The most common cause of infection, followed by moyamoya disease, cerebrovascular malformations and head trauma, there are still some unknown reasons.