Table of Content

20 June 2012, Volume 7 Issue 06

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主编手记

Understanding Children

WANG Yong-Jun

2012, 7(06):  437-439. 

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述评

Understanding and Diagnosis of Cerebrovascular Disease in Children

ZOU Li-Ping

2012, 7(06):  440-442. 

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论著

Age, Concomitant Symptoms and the Etiology of Acute Hemiplegia in Childhood

WANG Xin;WANG Li-Wen;LI Er-Zhen;et al

2012, 7(06):  443-447. 

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Objective To investgate the etiology of acute hemiplegia in childhood.Methods We did the retrospective research of the concomitant symptoms of 31 in hospital children with acute hemiplegia from Jan. 2007 to Dec. 2009 to find the relation between the cause and the symptoms. Among these patients, there were 5 infants, 12 toddlers, 4 children between 3 to 5 years, 10 children between 10 to 16 years old.Results The etiology varied, 9 patients suffered from central nervous system infections, 4 of them were babies; 4 brain vascular malformations, 3 toddlers; 2 patients had acute brain infarct after minor head injury; 5 inborn metabolic diseases and all were older than 10 years old; 4 hemiconvulsion-hemiplegia/hemiconvulsion-hemiplegia-epilepsy syndrome(HH/HHE); 2 alternating hemiplegia of childhood.Conclusions Lots of diseases can cause acute hemiplegia of childhood, in infants and toddlers, brain infections were the most common cause, and were less common in older children. Acute brain infarcts and brain vascular malfunction were not uncommon in toddler and preschool child with acute hemiplegia. Inborn metabolic errors were causes of acute hemiplegia in elder children.

Analysis of Risk Factors and Clinical Characteristics of Ischemic Stroke in Children

DENG Ya-Xian;GAO Bao-Qin;WANG Yi-Long;et al

2012, 7(06):  448-452. 

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Objective To summarize the risk factors, etiology and clinical features of ischemic stroke in children.Methods The clinical data of 81 children with ischemic stroke who were hospitalized in Beijing Tiantan Hospital Affiliated to the Capital Medical University from Jan. 2002 to Jun. 2011 were analyzed retrospectively. Eighty-one children were enrolled.Results There were 60 boys and 21 girls, median onset age of stroke was 6.99 years(ranged from 7 months to 18 years old). Risk factors and etiology included head trauma(37.04%), infection(16.05%), hyperhomocysteinemia(9.88%), vasculitis(7.4%), cardiac disease(6.17%), dissection(6.17%), moyamoya disease(4.94%), aneurysm(1.23%) and neurofibromatosis type I(1.23%). 28.4 percent(n=23) had no identifiable cause. The most frequent clinical manifestation was hemiplegia(92.6%). Central facial paralysis was found in 46 cases. Other neurological manifestation included abnormal feeling, headache and epilepsy. Basal ganglia infarction was found in sixty cases(74.1%) and infarction on the left side was more common than on the right.Conclusion The peak onset of arterial ischemic stroke(AIS) in children is in infancy. Hemiplegia is the most common neurological manifestation. Basal ganglia is the most common territory of infarction. Anterior circulation is more easily involved than posterior circulation.

Retrospective Analysis of Subarachnoid Hemorrhage in Children

TIAN Zhao-Xia;DENG Ya-Xian;YANG Wei-Li;et al

2012, 7(06):  453-455. 

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Objective To analyze the etiology,clinical features, imaging features and treatment of subarachnoid hemorrhage in children.Methods The clinical data of 18 children with subarachnoid hemorrhage who were hospitalized in Beijing Tiantan Hospital Affiliated to the Capital Medical University from Jan. 2003 to Jun. 2011 were analyzed retrospectively. Eighteen children were enrolled.Results There were 10 boys and 8 girls, median onset age was 11.33 years(ranged from 1 year to 18 years old). Etiology included mild trauma(22.2%), arteriovenous malformation of brain(16.7%), aneurysma(11.1%), hypertension(5.6%) and lower fibrinogen hematic disease(5.6%). 38.9 percent(n=7) had no identifiable cause. The most frequent clinical manifestation was headache(seen in 88.9% patients). Disturbance of consciousness was found in 5 cases. Other neurological manifestation included convulsion, dysarthria and muscle strength down. All cases were confirmed by imaging examination.Conclusion Subarachnoid hemorrhage can happen in any age. Headache and disturbance of consciousness are the most common neurological manifestations.

Basilar Artery Stenosis is an Independent Predictor of Poor Outcomes at Discharge in Patients with Isolated Pontine Infarction

JU Yi;CHEN Mei-Mei;LI Na;et al

2012, 7(06):  456-460. 

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Objective To compare the clinical presentation, intracranial and extracranial artery stenosis, and the short-term outcomes in patients with basilar artery(BA) stenosis with those without BA stenosis, and to investigate the associations between BA stenosis and poor outcomes in the patients with isolated pontine infarction at discharge.Methods In this prospective study, we recruited patients who were hospitalized for isolated pontine infarction within 7 days of symptom onset from October 2007 to August 2008. We compared the differences in risk factors, clinical features, the baseline neurologic impairment and the outcomes at discharge in patients with and without BA stenosis.Results A total of 101 patients with isolated pontine infarction were included in this study. Differences in central facial palsy and dysphagia(P=0.008 and 0.002) were observed among the 2 groups(with and without moderate to severe BA stenosis/occlusion). When the 2 groups were compared, the neurological impairments on admission were more severe in patients with moderate to severe BA stenosis/occlusion than in patients without BA stenosis(P=0.002). Those with moderate to severe BA stenosis/occlusion had higher incidences of concomitant stenosis of intracranial and/or extracranial artery than those without BA stenosis(P=0.009). The multivariable logistic-regression analysis showed that the significant outcome differences between patients with and without moderate to severe BA stenosis/occlusion when adjusted for potential confoundingfactors(OR 2.7, 95%CI 1.07-7.02, P=0.04).Conclusions Patients of isolated pontine infarction with moderate to severe BA stenosis/occlusion had higher incidences of concomitant stenosis of other intracranial and/or extracranial artery. Moderate to severe BA stenosis/occlusion was an independent predictor for poor outcomes at discharge after stroke onset in patients with isolated pontine infarction.

Preliminary Study for Association of Blood Pressure and Heart Rate on Carotid Hemodynamics

QIN Hai-Qiang;ZHAO Xing-Quan;ZHOU Ping;et al

2012, 7(06):  461-465. 

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Objective To study the effect of blood pressure and heart rate on the hemodynamics of common carotid artery(CCA).Methods Sixteen healthy volunteers were studied. Wall shear stress(WSS) values localized at CCA 2 cm below the bifurcation were calculated with cine phase-contrast magnetic resonance(MR) imaging combined three-dimensional paraboloid(3DP) model. On the spatial distribution, carotid wall was divided by 24 equal parts. Calculate the mean WSS in a cardiac cycle on the each part, and choose the minimal WSS value. Then we observed the effect of systolic pressure, diastolic pressure, mean arterial pressure, or heart rate on the average WSS and minimal WSS.Results Total 32 carotid arteries of 16 health volunteers were examined, in which 3 carotid arteries were excluded because of uninterpretable high-resolution magnetic resonance imaging(MRI) findings. In the remaining 29 common carotid arteries analyzed, the average WSS and the minimal WSS during a cardiac cycle on the spatial distribution have no significant correlation with systolic pressure, diastolic pressure, mean arterial pressure, or heart rate(P>0.05) in spite of bilateral carotids, left carotids or right carotids.Conclusion In health population, both average WSS and minimal WSS have no significant correlation with blood pressure or heart rate.

Application Value of Source Images by Three-Dimensional Time-of-Flight Magnetic Resonance Angiography in Detecting Cerebral Microbleeds

SUI Bin-Bin;GAO Pei-Yi;LIN Yan;et al

2012, 7(06):  466-471. 

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Objective To study the value of source images of three dimensional time-of-flight magnetic resonance angiography(3D-TOF MRA) in detecting cerebral microbleeds(CMBs) in brain parenchyma.Methods Two hundred and eighty patients who were suspected to have microbleeding lesions were recruited. T2* gradient recall echo(GRE) sequence and 3D-TOF MRA sequences were performed after routine magnetic resonance(MR) head imaging were performed. Numbers, location, and scales of CMBs on 3D-TOF MRA axial source images and T2*GRE images were compared.Results Seven-five cases were proved to have CMBs by T2*GRE sequence. Nine cases which could not be compared were excluded. On T2*GRE images, three hundred and thirty eight CMBs were found with 50 cases as grade 1, 10 cases as grade 2, and 6 cases as grade 3. On 3D-TOF MRA source images, two hundred and forty two CMBs were found with 11cases as grade 0, 40 cases as grade 1, 12 cases as grade 2, and 3 cases as grade 3. Paired-sample t test showed that there were significant difference between CMBs found by two methods at cortical/subcortical area(P=0.000), thalami(P=0.001), and cerebellum(P=0.039), while no significant difference were found between CMBs found by two methods at basal ganglia(P=0.581) and brain stem(P=0.211). Consistency of two different sequences showed Kappa value was 0.494(P=0.092).Conclusion Source images of 3D-TOF MRA can be used to detect CMBs. Though CMBs on 3D-TOF MRA source images were not as clear as those on T2*GRE images, when T2*GRE images are absent, 3D-TOF MRA source images may be helpful to display microbleeds lesions and suggest further examination.

专题论坛

Research and Development in Stroke Collaboration of International Children

YANG Guang;ZOU Li-Ping

2012, 7(06):  473-475. 

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病例讨论

A Case of Spinal Cord Vascular Malformation Characterized by Repeated Hyperspasmia and Headache

YANG Guang;ZOU Li-Ping;WANG Jun;et al

2012, 7(06):  476-478. 

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指南与规范

Focused 2012 Update of the Canadian Cardiovascular Society Atrial Fibrillation Guidelines: Recommendations for Stroke Prevention and Rate/Rhythm Control

HUA Xu;XIA Qing;MA Li;et al

2012, 7(06):  479-485. 

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综述

Varicella-Zoster Virus Infection and Ischemic Stroke

WANG Hua;SHEN Yan-Wen

2012, 7(06):  486-491. 

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Varicella-zoster virus(VZV) infection may lead to central and peripheral vasculopathy. Post-infection vasculopathy of VZV is one of the most important reasons for diseases of central systems like cerebrospinal hypoxia and ischemic infarctions, aneurysms, intracerebral hemorrhage and subarachnoid hemorrhage during childhood. During the latest decades, there are increasing cases of post-VZV strokes. However, the mechanics remains unclear, and the protean clinical manifestations and the treatment are to be further studied.

Stroke in Children

DENG Ya-Xian;WANG Yong-Jun;GAO Bao-Qin

2012, 7(06):  492-497. 

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The risk factors and etiology of stroke in children are different from that in adults. Hypertension, hyperlipidemia and diabetes mellitus are major causes of stroke in adulthood. However, the causes of stroke in childhood are rather complicated. Cerebral arteriopathy, congenital diseases such as congenital heart disease, sickle cell disease and blood diseases are common diseases that resulting in stroke in children. Recurrence rate and mortality are higher in children stroke. This study will review the epidemiology, risk factors, etiologies, treatment and prevention of stroke in children.

Natural History of Intracranial Atherosclerosis

XU Zi-Qi;GAO Kun;XU Xiao-Tong;et al

2012, 7(06):  498-503. 

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Atherosclerosis is a systemic disease. Intracranial arteries are one of the most arteries which frequently involved by atherosclerosis. The 8%-10% patients with ischemic stroke is due to intracranial atherosclerosis. Intracranial atherosclerotic stenosis is also regarded as inflammatory process. Many studies have found that the oxidized low density lipoprotein(LDL-C) plays a key role in the process of atherosclerosis. The most frequently sites involved by atherosclerosis including the carotid-cavernous siphon, middle cerebral artery, intracranial vertebral artery and basilar artery. Recently, studies on intracranial atherosclerosis have obtained significantly progress in the field of epidemiology, natural history, pathophysiology and drug therapy, interventional therapy. In this review, we want to summarize the natural history of patient with the intracranial atherosclerosis.

教学园地

Exploration on Clinical Neurology Graduate Training Model

CHEN Zan;WANG Kun;JIAN Feng-Zeng;et al

2012, 7(06):  504-507. 

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抗凝园地

Questions Answered by Professor Yongjun Wang at the 2012 World Stroke Window China Lecture Tour

2012, 7(06):  508-512. 

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