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[Clinical analysis of cerebral infarction in children]
1Department of Neurosurgery, Sendai City Hospital.
Insights
Pediatric cerebral arterial occlusive disease, often affecting children under 4, can present with hemiplegia. Conservative treatment shows promising outcomes due to high recanalization rates in children.
Area of Science:
- Neurology
- Pediatric Neurology
- Vascular Neurology
Background:
- Cerebral arterial occlusive disease (CAOD) in children is rare but can lead to significant neurological deficits.
- Understanding the causes, presentation, and prognosis of pediatric CAOD is crucial for timely intervention.
Observation:
- Six pediatric cases of CAOD were analyzed, with most cases presenting before age 4.
- Common causes included trauma, infection, and intraarterial myxoma, with unknown etiologies in some instances.
- Initial symptoms frequently involved sudden hemiplegia, with angiography revealing stenosis in middle or anterior cerebral arteries.
Findings:
- Angiography identified diffuse and localized stenosis patterns in affected cerebral arteries.
- Computed tomography (CT) showed low-density areas in the putamen in cases without demonstrable stenosis.
- Follow-up angiography indicated stenosis improvement in three cases, suggesting potential for recanalization.
Implications:
- Conservative management appears effective for pediatric CAOD, contrary to initial concerns about poor prognosis.
- Children exhibit higher recanalization rates compared to adults, necessitating caution with acute-stage surgical revascularization.
- Further research into pediatric CAOD is warranted to optimize treatment strategies and improve long-term outcomes.
Abstract:
Six cases of cerebral occlusive disease in children were reported. The cerebral arterial occlusive disease had its onset at the age of less than 4 years, except for one case of a 9 year-old. The causes of occlusion were, trauma in two cases, infectious disease in one case, intraarterial myxoma in one case and an unknown reason in two cases. Initial symptoms were sudden onset of hemiplegia in 5 cases, and headache in one case. Angiography revealed stenosis of the main trunk of the middle cerebral artery, or of the anterior cerebral artery in 4 cases. Angiographical manifestations of stenosis in 4 cases were classified into two types, diffuse stenosis and localized stenosis. No stenotic changes were demonstrated in two cases, in which CT revealed a small low density area in the putamen. Follow up angiogram in three cases revealed improvement of stenosis. Though therapy in all cases was conservative, their prognosis is not so poor as had been considered. As the rate of recanalization in children was assumed to be high as compared with adult cases, it was considered that surgical revascularization in the acute stage had to be undergone very carefully.