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目的探讨儿童外伤后基底节区梗死的临床和影像学特征及预后,提高诊治水平。方法分析2010年8月—2015年8月入住陆军总医院附属八一儿童医院神经发育科并确诊外伤后基底节区梗死的19例患儿临床和影像学资料,对预后进行随访。结果本组男11例,女8例,发病年龄6个月~5岁,3岁以下15例(78.9%)。床坠落伤8例(42.1%),跌伤6例(31.6%),打击伤3例(15.8%),碰撞伤2例(10.5%)。19例均表现明显的偏瘫,出现在外伤后24 h内7例(36.8%),24~48 h 8例(42.1%),48 h~7 d 4例(21.1%)。左侧偏瘫11例,右侧偏瘫8例。肌力为0~2级7例,2+~4级12例。伴烦躁7例,呕吐5例,言语不清4例,抽搐2例。19例头颅MRI检查均显示基底节区长T1长T2信号,FLAIR高信号,DWI呈明显高信号,无占位效应。19例均给予内科保守治疗,并进行康复训练。10例住院2周,9例住院3周。其中11例出院时肌力正常。随访时间6个月~5年,2例失访,17例神经系统查体未见异常,13例6岁以下患儿进行Gesell发育评估,均于边缘至正常。结论儿童外伤后基底节区梗死多发生于婴幼儿,外伤一般较轻,偏瘫程度不等,头颅MRI检查有助于早期发现病灶,经过积极内科治疗预后较好。
Objective To investigate the clinical and radiological features and prognosis of basilar infarct in children with traumatic injury and to improve the diagnosis and treatment. Methods From August 2010 to August 2015, the clinical and imaging data of 19 children admitted to Department of Neurodevelopment, Bayi Children’s Hospital Affiliated to the General Hospital of PLA and diagnosed post-traumatic basal ganglia infarction were followed up. Results The group of 11 males and 8 females, the age of onset of 6 months to 5 years old, 15 years of age 3 (78.9%). Bed fall injury in 8 cases (42.1%), fall injury in 6 cases (31.6%), hit injury in 3 cases (15.8%), collision injury in 2 cases (10.5%). Seventeen patients (36.8%) within 24 h after trauma, 8 patients (42.1%) from 24 to 48 h, and 4 patients (21.1%) from 48 h to 7 d showed obvious hemiplegia in all 19 patients. Left hemiplegia in 11 cases, right hemiplegia in 8 cases. Muscle strength 0 to 2 in 7 cases, 2 + ~ 4 in 12 cases. With irritability in 7 cases, vomiting in 5 cases, 4 cases of verbal ill, convulsions in 2 cases. 19 cases of cranial MRI examination showed basal ganglia long T1 long T2 signal, FLAIR high signal, DWI was significantly higher signal, no mass effect. 19 cases were given medical conservative treatment, and rehabilitation training. 10 hospitalized 2 weeks, 9 hospitalized 3 weeks. Eleven of them were normal muscle strength at discharge. The follow-up time ranged from 6 months to 5 years. Two patients were lost to follow-up. No abnormalities were found in 17 patients with neurological examination. Gesell development was evaluated in 13 children under 6 years of age with margins to normal. Conclusion The basal ganglia infarction occurred mostly in infants and young children after traumatic brain injury. The traumatic injuries were generally mild and the degrees of hemiplegia were different. The cranial MRI examination was helpful for the early detection of the lesion, and the prognosis was good after active medical treatment.