RESUMO
A pathogenetic model of infantile cerebral palsy caused by maternal antiphospholipid (APS) syndrome has been elaborated. Thirty-two children with cerebral palsy born to mothers with clinical signs of APS have been studied. The basic clinical feature of cerebral palsy in children was the prevalence of the double hemiplegic form, the absence of severe cognitive disorders, global muscular hypotrophy, rapid contracture formation and a tendency to frequent respiratory diseases. A seropositive APS variant was found in 42% of mothers examined, the seronegative one--in 58%. Such factors as (1) fetoplacental insufficiency and hypoxia caused by vascular infarctions of the placenta; (2) transplacental passage of antiphospholipid antibodies from a mother to a child; (3) intracerebral hemorrhages and periventricular leucomalacia in infants play the key role in the pathogenesis of cerebral palsy in children born to mothers with APS.
Assuntos
Síndrome Antifosfolipídica/complicações , Paralisia Cerebral/etiologia , Adolescente , Adulto , Anticorpos Antifosfolipídeos/sangue , Síndrome Antifosfolipídica/imunologia , Paralisia Cerebral/epidemiologia , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Prevalência , Estudos Retrospectivos , Índice de Gravidade de Doença , Ucrânia/epidemiologiaRESUMO
Based on the literature and their own observations of 44 children aged 5-15 years (27 girls, 17 boys) with prior strokes, the authors characterize the types of strokes and principle causes of the disease as follows: (1) intracerebral and subarachnoidal hemorrhages (key etiology--arteriovenous malformations, blood disorders, coagulopathy, thrombocytopenias, thrombocytopathy, etc.) and (2) ischemic strokes i.e. (i) thrombotic (congenital and acquired vascular aplasias, angiitis, antiphospholipoid and viral vasculopathy, blood system coagulate activation, etc.); (ii) embolic (cardiogenic, septic, placental, etc.) and (iii) hemodynamic as a consequence of severe cardiomyopathy and disrupted total hemodynamics. The definitions of metabolic stroke as a complication of mitochondrial encephalopathy, homocystinuria and non-differentiated stroke caused more often by emergence of pathologic weariness of connective tissues were suggested. To elicit the stroke causes and types in children, the authors propose a reliable algorithm for clinico-instrumental diagnostic screening in acute period of stroke.
