婴幼儿轻度脑外伤后基底节梗死的临床特点及其远期随访研究

Clinical characteristics and long-term follow-up study of basal ganglia infarction after minor head trauma in infants and young children

摘要:

目的 探讨婴幼儿轻度脑外伤后基底节梗死（basal ganglia infarction after minor head trauma, BGIMHT）的临床特点及预后。方法 回顾性分析2011年1月—2022年1月在苏州大学附属儿童医院住院的28 d至3岁BGIMHT患儿的临床资料和随访结果。结果 纳入的45例BGIMHT患儿中，最常见症状为肢体活动障碍（96%，43/45），其次为面瘫（56%，25/45），头颅影像学见梗死伴基底节钙化占72%（31/43）。经保守治疗后，42例（93%）患儿症状改善，3例（7%）出现卒中反复。中位随访时间82（范围：17~141）个月，截至末次随访，97%（29/30）残留基底节软化灶；29例参与问卷随访，复发和康复问卷评估示66%（19/29）患儿恢复正常，17%（5/29）症状明显改善，17%（5/29）改善欠佳；全球疾病负担重点控制项目分级量表评估示仅1例（3%）残存严重后遗症。无神经系统后遗症患儿及有神经系统后遗症患儿的起病年龄、性别及有无合并BGC比较差异无统计学意义（P>0.05）。结论 BGIMHT最常见首发症状为肢体活动障碍，影像学结果见大部分患儿同时存在颅内钙化灶，多数梗死灶后期转化为软化灶，总体预后良好。

Abstract:

Objective To investigate the clinical characteristics and prognosis of infants and young children with basal ganglia infarction after minor head trauma (BGIMHT).Methods A retrospective analysis was conducted on the clinical data and follow-up results of children aged 28 days to 3 years with BGIMHT who were hospitalized at Children's Hospital of Soochow University from January 2011 to January 2022.Results A total of 45 cases of BGIMHT were included, with the most common symptom being limb movement disorders (96%, 43/45), followed by facioplegia (56%, 25/45). Cerebral imaging showed that 72% (31/43) had infarction accompanied by basal ganglia calcification. After conservative treatment, 42 children (93%) showed significant symptom improvement, while 3 children (7%) experienced recurrent strokes. The median follow-up time was 82 months (range: 17-141 months). At the last follow-up, 97% (29/30) had residual basal ganglia softening lesions. Among 29 cases participating in questionnaire follow-up, 66% (19/29) recovered normally, 17% (5/29) showed significant improvement in symptoms, and 17% (5/29) had poor improvement. According to the grading of the Global Burden of Disease Control Projects, only 1 child (3%) had severe sequelae. There were no significant differences in age at onset, gender, or presence of concomitant basal ganglia calcification between children with and without neurological sequelae (P>0.05).Conclusions The most common initial symptom of BGIMHT is limb movement disorder, and imaging results indicate that most children have concurrent intracranial calcifications. Most infarct lesions later transform into softening lesions, resulting in a generally good prognosis.