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"Chinese Stroke Journal" is a high-level academic journal of the medical profession headed by the Ministry of Science and Technology of the People's Republic of China, sponsored by the Chinese Institute of Science and Technology Information, and undertaken by the Chinese Stroke Society
.
In order to strengthen the medical information exchange in the field of cerebrovascular diseases, improve the academic level of medicine, and serve the majority of medical technology and health workers, the Chinese Journal of Stroke and the Yimaitong platform jointly launched a series of columns-"Stroke "Miscellaneous" Talks"
.
This column selects the high-quality content related to stroke in each issue of the Chinese Journal of Stroke, adapts it, and publishes it on the "Yimaitong Neurology" public account.
I look forward to learning and discussing stroke-related diseases with you! This article is organized: Text/Tang Jiu (Chinese Stroke Journal) Note: This article has been officially authorized by the "Chinese Stroke Journal", please do not reprint without authorization
.
The original source of the article: Lan Yina, Lu Jinhao.
A case of cerebellar hemisphere cerebral infarction in children with ataxia[J].
Chinese Journal of Stroke, 2021, 16(05): 446-448.
Literature download link: http:/ / Review of previous issues ↓↓↓ Issue 1: Why is it said that playing games can cure cognitive impairment? This review tells you the second issue: How to build a high-quality biobank of cerebrovascular diseases? The Temple of Heaven experience is here! Phase 3: The lower the level of T3 and FT3, the more severe the cognitive impairment in stroke patients? Shijiazhuang City People’s Hospital published an important correlation analysis of rare case profiles-a 12-year-old child with a stroke caused by minor head trauma, a 2-year-old male patient admitted to the hospital with unsteady gait, due to "sudden gait instability, trunk swing, gait Ji Zengkuan was admitted to the hospital for 6 days
.
The child cried after bumping the sofa 6 days before admission, making fists with both hands, flexing both upper limbs, accompanied by non-jetting vomiting, a small amount of stomach contents, no obvious lump on the head, and then falling asleep
.
At 2 o'clock in the morning the next day, the parents found that the child was skewed to the left, unsteady sitting alone, unwilling to stand, and crying while standing
.
Routine blood examinations in the outside hospital showed no abnormalities in the counts of white blood cells, neutrophils, lymphocytes, red blood cells, and platelets; blood biochemical examinations, blood ammonia, and lactic acid levels were not abnormal
.
Check the children's EEG, the results showed that they were in the normal range
.
According to past history, in October 2017, the child fell while walking, landed on the back of his head, and locally appeared small masses, but the activity was normal; he denied the history of blood transfusion, drug and food allergies, and the vaccination was carried out as planned
.
2 After a comprehensive examination, abnormal imaging results were found.
Nervous system examination on admission found that sitting alone, walking alone was not stable, the step base was widened, and the rest were normal
.
Laboratory examination found (2018-01-31): white blood cell count 11.
72×109/L, neutrophil percentage 45.
3%, lymphocyte percentage 46.
6%, platelet count 516×109/L, hemoglobin 129 g/L, CRP 0.
1 mg/dL; 9 items of respiratory pathogens except influenza B virus test showed weak positive, but no obvious abnormalities were found
.
Imaging examination: Lumbar MRI plain scan results suggest that the child may have spina bifida in lumbar 5 and sacrum 1
.
Head MRI examination showed abnormal signals in the right cerebellar vermis and cerebellar hemispheres.
T2-weighted imaging showed slightly higher signals and DWI showed slightly lower signals.
Three-dimensional quasi-continuous arterial spin-labeled perfusion imaging showed obvious high perfusion in the lesion.
It was obviously strengthened (Figure 1)
.
3 Final diagnosis: Trauma caused subacute cerebral infarction of the cerebellum.
First of all, through questioning, it was learned that the child had ataxia such as gait instability, trunk swing, and broadened base step after the head hit the sofa before admission
.
The head MRI examination in our hospital showed that the DWI of the right cerebellar vermis and cerebellar hemisphere showed slightly low signal, which did not conform to the typical subacute cerebral infarction
.
However, by comparing the MRI results of the outside hospital on the second day of the child’s onset, abnormal signals were seen in the right cerebellar vermis and cerebellar hemisphere, DWI showed obvious high signal (Figure 2), ADC was low signal, and the final diagnosis was the cerebellum caused by trauma.
Cerebral infarction in subacute phase is complicated by high perfusion
.
After diagnosis, our hospital was given mecobalamin to nourish nerves, mannitol to lower intracranial pressure and symptomatic treatment.
Subsequently, the symptoms of the child gradually improved.
After 8 days, the gait improved, the trunk swaying improved during walking and was discharged from the hospital
.
4 Analysis: Stroke caused by minor head trauma? The causes of stroke in children are complex and diverse.
Some scholars have summarized the common causes of stroke in children under 5 years of age, and found that the most common cause of stroke is local cerebral artery disease, stroke caused by acute head and neck trauma caused by fall or collision.
Only accounted for 26%
.
In this case, except for a history of minor head trauma (GCS 13-15 points) before the onset, there was no obvious abnormality in the rest, so it was considered as a stroke caused by minor head trauma
.
Cerebellar infarction in children caused by trauma is extremely rare, and only a few cases have been reported
.
The specific pathogenesis of the disease is not yet clear.
It is speculated that the possible cause is the immature brain development of children.
Minor trauma can act on the brain parenchyma through the skull, and the progress of the brain parenchyma will cause the movement of cerebral blood vessels, resulting in vascular endothelial damage and vasospasm.
.
Children with cerebral infarction usually need to be diagnosed with clinical history and MRI results
.
DWI plays an important role in the diagnosis and staging of cerebral infarction.
In the hyperacute phase (<6 h), acute phase (6 to 72 h), and subacute phase (4 to 10 d), DWI usually shows high signal until chronic The DWI signal will gradually decrease to lower than the normal brain parenchymal signal in the early stage (11-30 d) and the chronic late stage (>1 month)
.
However, on the 8th day of the onset (subacute stage), the DWI signal of the lesion was lower than that of the brain parenchyma, which was significantly enhanced with hyperperfusion, and was easily misdiagnosed as a cerebellar hemisphere tumor or non-tumor lesion
.
In addition, the high signal displayed by DWI in this case is lower than the brain parenchymal signal in the subacute phase, which does not conform to the law of time evolution
.
It is speculated that the possible reason is that the elasticity and compliance of the blood vessel wall in children are better.
After a mild head trauma, the elasticity of the blood vessel wall can be quickly restored, so as to achieve early reperfusion
.
Wonderful comment——Professor Ju Yi from Beijing Tiantan Hospital, Capital Medical University — Professor Ju Yi, chief physician and doctoral tutor of Beijing Tiantan Hospital, Capital Medical University.
Stroke is one of the main causes of child deaths
.
When a child seeks medical attention, the symptoms of acute neurological deficit may be ignored because the child is young or uncooperative, and stroke may be ignored as the cause of the disease
.
Neuroimaging is very important for the diagnosis of stroke in children, but the special compensatory mechanism and vascular anatomy characteristics of children may make DWI signal and perfusion changes inconsistent with the time evolution of common cerebral infarction
.
This article reports a case of cerebellar hemisphere cerebral infarction in children after trauma.
The MRI manifestations of children’s subacute cerebral infarction are analyzed in detail.
The imaging features are not consistent with the typical manifestations of cerebral infarction, and the special mechanism is discussed.
The important role in the diagnosis of infarction has certain reference significance for the early recognition and diagnosis of cerebral infarction in children after trauma
.
.
In order to strengthen the medical information exchange in the field of cerebrovascular diseases, improve the academic level of medicine, and serve the majority of medical technology and health workers, the Chinese Journal of Stroke and the Yimaitong platform jointly launched a series of columns-"Stroke "Miscellaneous" Talks"
.
This column selects the high-quality content related to stroke in each issue of the Chinese Journal of Stroke, adapts it, and publishes it on the "Yimaitong Neurology" public account.
I look forward to learning and discussing stroke-related diseases with you! This article is organized: Text/Tang Jiu (Chinese Stroke Journal) Note: This article has been officially authorized by the "Chinese Stroke Journal", please do not reprint without authorization
.
The original source of the article: Lan Yina, Lu Jinhao.
A case of cerebellar hemisphere cerebral infarction in children with ataxia[J].
Chinese Journal of Stroke, 2021, 16(05): 446-448.
Literature download link: http:/ / Review of previous issues ↓↓↓ Issue 1: Why is it said that playing games can cure cognitive impairment? This review tells you the second issue: How to build a high-quality biobank of cerebrovascular diseases? The Temple of Heaven experience is here! Phase 3: The lower the level of T3 and FT3, the more severe the cognitive impairment in stroke patients? Shijiazhuang City People’s Hospital published an important correlation analysis of rare case profiles-a 12-year-old child with a stroke caused by minor head trauma, a 2-year-old male patient admitted to the hospital with unsteady gait, due to "sudden gait instability, trunk swing, gait Ji Zengkuan was admitted to the hospital for 6 days
.
The child cried after bumping the sofa 6 days before admission, making fists with both hands, flexing both upper limbs, accompanied by non-jetting vomiting, a small amount of stomach contents, no obvious lump on the head, and then falling asleep
.
At 2 o'clock in the morning the next day, the parents found that the child was skewed to the left, unsteady sitting alone, unwilling to stand, and crying while standing
.
Routine blood examinations in the outside hospital showed no abnormalities in the counts of white blood cells, neutrophils, lymphocytes, red blood cells, and platelets; blood biochemical examinations, blood ammonia, and lactic acid levels were not abnormal
.
Check the children's EEG, the results showed that they were in the normal range
.
According to past history, in October 2017, the child fell while walking, landed on the back of his head, and locally appeared small masses, but the activity was normal; he denied the history of blood transfusion, drug and food allergies, and the vaccination was carried out as planned
.
2 After a comprehensive examination, abnormal imaging results were found.
Nervous system examination on admission found that sitting alone, walking alone was not stable, the step base was widened, and the rest were normal
.
Laboratory examination found (2018-01-31): white blood cell count 11.
72×109/L, neutrophil percentage 45.
3%, lymphocyte percentage 46.
6%, platelet count 516×109/L, hemoglobin 129 g/L, CRP 0.
1 mg/dL; 9 items of respiratory pathogens except influenza B virus test showed weak positive, but no obvious abnormalities were found
.
Imaging examination: Lumbar MRI plain scan results suggest that the child may have spina bifida in lumbar 5 and sacrum 1
.
Head MRI examination showed abnormal signals in the right cerebellar vermis and cerebellar hemispheres.
T2-weighted imaging showed slightly higher signals and DWI showed slightly lower signals.
Three-dimensional quasi-continuous arterial spin-labeled perfusion imaging showed obvious high perfusion in the lesion.
It was obviously strengthened (Figure 1)
.
3 Final diagnosis: Trauma caused subacute cerebral infarction of the cerebellum.
First of all, through questioning, it was learned that the child had ataxia such as gait instability, trunk swing, and broadened base step after the head hit the sofa before admission
.
The head MRI examination in our hospital showed that the DWI of the right cerebellar vermis and cerebellar hemisphere showed slightly low signal, which did not conform to the typical subacute cerebral infarction
.
However, by comparing the MRI results of the outside hospital on the second day of the child’s onset, abnormal signals were seen in the right cerebellar vermis and cerebellar hemisphere, DWI showed obvious high signal (Figure 2), ADC was low signal, and the final diagnosis was the cerebellum caused by trauma.
Cerebral infarction in subacute phase is complicated by high perfusion
.
After diagnosis, our hospital was given mecobalamin to nourish nerves, mannitol to lower intracranial pressure and symptomatic treatment.
Subsequently, the symptoms of the child gradually improved.
After 8 days, the gait improved, the trunk swaying improved during walking and was discharged from the hospital
.
4 Analysis: Stroke caused by minor head trauma? The causes of stroke in children are complex and diverse.
Some scholars have summarized the common causes of stroke in children under 5 years of age, and found that the most common cause of stroke is local cerebral artery disease, stroke caused by acute head and neck trauma caused by fall or collision.
Only accounted for 26%
.
In this case, except for a history of minor head trauma (GCS 13-15 points) before the onset, there was no obvious abnormality in the rest, so it was considered as a stroke caused by minor head trauma
.
Cerebellar infarction in children caused by trauma is extremely rare, and only a few cases have been reported
.
The specific pathogenesis of the disease is not yet clear.
It is speculated that the possible cause is the immature brain development of children.
Minor trauma can act on the brain parenchyma through the skull, and the progress of the brain parenchyma will cause the movement of cerebral blood vessels, resulting in vascular endothelial damage and vasospasm.
.
Children with cerebral infarction usually need to be diagnosed with clinical history and MRI results
.
DWI plays an important role in the diagnosis and staging of cerebral infarction.
In the hyperacute phase (<6 h), acute phase (6 to 72 h), and subacute phase (4 to 10 d), DWI usually shows high signal until chronic The DWI signal will gradually decrease to lower than the normal brain parenchymal signal in the early stage (11-30 d) and the chronic late stage (>1 month)
.
However, on the 8th day of the onset (subacute stage), the DWI signal of the lesion was lower than that of the brain parenchyma, which was significantly enhanced with hyperperfusion, and was easily misdiagnosed as a cerebellar hemisphere tumor or non-tumor lesion
.
In addition, the high signal displayed by DWI in this case is lower than the brain parenchymal signal in the subacute phase, which does not conform to the law of time evolution
.
It is speculated that the possible reason is that the elasticity and compliance of the blood vessel wall in children are better.
After a mild head trauma, the elasticity of the blood vessel wall can be quickly restored, so as to achieve early reperfusion
.
Wonderful comment——Professor Ju Yi from Beijing Tiantan Hospital, Capital Medical University — Professor Ju Yi, chief physician and doctoral tutor of Beijing Tiantan Hospital, Capital Medical University.
Stroke is one of the main causes of child deaths
.
When a child seeks medical attention, the symptoms of acute neurological deficit may be ignored because the child is young or uncooperative, and stroke may be ignored as the cause of the disease
.
Neuroimaging is very important for the diagnosis of stroke in children, but the special compensatory mechanism and vascular anatomy characteristics of children may make DWI signal and perfusion changes inconsistent with the time evolution of common cerebral infarction
.
This article reports a case of cerebellar hemisphere cerebral infarction in children after trauma.
The MRI manifestations of children’s subacute cerebral infarction are analyzed in detail.
The imaging features are not consistent with the typical manifestations of cerebral infarction, and the special mechanism is discussed.
The important role in the diagnosis of infarction has certain reference significance for the early recognition and diagnosis of cerebral infarction in children after trauma
.
