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目的分析儿童外伤性基底节腔隙性脑梗死的临床与治疗。方法回顾性分析1997-2004年复旦大学儿科医院31例儿童外伤性基底节腔隙性脑梗死临床资料。结果31例外伤性腔隙性脑梗死中6个月至1岁22例(71.0%);跌坠伤26例(83.9%);偏瘫症状最早至外伤后4h出现;以左侧偏瘫为主(19例),是右侧(11例)的1.7倍;肢体瘫痪程度以Ⅱ~Ⅲ级居多。外伤4~12hCT检查均为阴性,MRI检查有2例阳性;外伤后25~72hCT、MRI均为阳性结果。予MRA检查8例,阳性结果仅2例;CT、MRI、MRA阳性结果均提示基底节区有缺血梗死灶,12例(38.7%)CT检查结果示基底节点或片状钙化。2000年以后组21例加用超小剂量低分子肝素钠(LWMH)治疗可明显缩短起效时间。经观察未见出血等副反应。结论外伤性腔隙性脑梗死主要发生在婴幼儿,外伤程度轻微,症状常迟发,以左侧偏瘫为主,肢体瘫痪程度较重。外伤早期CT扫描可呈阴性结果,而在12~24h后开始显示缺血,MRI早于梗死后6~12h即可显示缺血改变,MRA对小血管显示不充分。该病可能与基底节钙化有关。采用超小剂量LWMH治疗安全有效。
Objective To analyze the clinical and treatment of pediatric traumatic basal ganglia lacunar infarction. Methods The clinical data of 31 children with traumatic basal ganglia lacunar infarction in 1997-2004 pediatric hospital of Fudan University were analyzed retrospectively. Results Twenty-one cases (71.0%) had traumatic lacunar infarction from 6 months to 1 year old, 26 cases (83.9%) had falling wounds, and the symptoms of hemiplegia appeared at least 4 hours after trauma. The left hemiplegia was predominant 19 cases), which is 1.7 times of the right side (11 cases). The degree of paralysis of limbs is mostly Ⅱ ~ Ⅲ. Trauma 4 ~ 12hCT examination were negative, MRI examination in 2 cases were positive; trauma 25 ~ 72hCT, MRI were positive results. There were 8 cases with MRA and only 2 cases with positive results. The CT, MRI and MRA positive results showed ischemic infarction in the basal ganglia, and the CT findings in 12 cases (38.7%) showed basal ganglia or lamellar calcification. After 2000 group of 21 cases with ultra-low dose of low molecular weight heparin (LWMH) treatment can significantly shorten the onset time. No bleeding and other side effects were observed. Conclusions Traumatic lacunar infarction mainly occurs in infants and young children. The degree of traumatic injury is slight and the symptoms are delayed. The left hemiplegia is the main part, and the paralysis of the limbs is serious. Early CT scan showed negative results, and began to show ischemia after 12 ~ 24h, MRI early 6 ~ 12h after infarction can be displayed ischemic changes, MRA showed inadequate on the small blood vessels. The disease may be related to basal ganglia calcification. Ultra-low dose LWMH treatment is safe and effective.