Analysis of 27 cases of cerebral infarction in critically ill children / 中国小儿急救医学

ABSTRACT

Objective:To explore the clinical characteristics and early diagnosis of cerebral infarction in critically ill children.Methods:The clinical data of the children who were diagnosed with cerebral infarction in PICU at Shengjing Hospital of China Medical University from January 2013 to September 2019 were analyzed retrospectively.Results:There were 27 children in this study, including 15 males and 12 females.The age of onset ranged from 1 month to 13 years old, with age of 3.0(0.7, 8.0) years old.Among 27 cases, there were ten cases of infection(37.0%), six cases of trauma(22.2%), three cases of congenital heart disease (11.1%), two cases of cerebrovascular disease (7.4%), one case of diabetic ketoacidosis(3.7%) and two cases of autoimmune factors(7.4%). The cause was unknown in three cases(11.1%). The main clinical manifestations were convulsion in 11 cases(40.7%), status convulsion in five cases(18.6%), limb dysfunction in four cases(14.8%), disturbance of consciousness in fvie cases(18.5%) and facial paralysis in four cases(14.8%). Among 27 cases, mechanical ventilation was performed in 12 cases (44.4%). The levels of D-dimer in all children were increased in varying degrees.After improvement and discharge, two children developed secondary epileptic sequelae.Head CT examination was performed in 20 cases, of which 11 cases showed definite cerebral infarction, eight cases of temporal lobe lesions and three cases of basal ganglia lesions.MRI+ MRA examination of the head in 27 cases showed that there were cerebral infarction and the infarct area large.Conclusion:The high incidence age of cerebral infarction in critically ill children is infantile.The most common diseases are infection, trauma, congenital heart disease, and the first clinical manifestations are convulsion and coma.Imaging examination showed that a high proportion of children had large area infarction, and the diagnostic effect of MRI is better than that of CT.D-dimer may be helpful for early clinical diagnosis.