Spontaneous Intracerebral Hemorrhage in Children

小孩之自發性腦出血

林志隆(Chich-Lung Lin) ； 羅永欽(Joon-Khim Loh) ； 關皚麗(Aij-Lie Kwan) ； 洪純隆 (Shen-Long Howng)

《The Kaohsiung Journal of Medical Sciences》 15卷3期 (1999/03) Pp. 146-151

https://doi.org/10.6452/KJMS.199903.0146

摘要

在九年間我們共收集42位非外傷性腦出血的小孩，一半的病人入院時的昏迷指數為滿分。最常見的症狀為頭痛（67％），其前罔意識喪失（52％）及嘔吐（50％）。三位病人起初被診斷為腦膜炎，兩位病人被診斷為感冒。大多數出血的部位為腦葉（62％）及小腦（17％）。28位病人接受腦血管攝影檢查，其中19位病人（68％）發現血管疾病。磁振攝影及病理學檢查確定兩位海綿狀血管瘤，血液檢查診斷出兩位急性血癌的病人。共有四種腦出血的原因，在23位病人（55％）中發現。動靜脈畸形為最常見的原因。住院存活率為79％。入院時的昏迷指數在3-5分者，及出血在腦幹、小腦及多發性出血的病人有較高的死亡率，。追蹤期間從6至104個月（平均42個月），70％回復到出血前狀況，21％恢復良好僅有些許功能損失，3％有嚴重功能損失，6％死亡。小孩腦出血的運動功能恢復比成人快，但視力缺損經常持續存在。

並列摘要

We reviewed our experience in 42 children younger than 16 years with spontaneous intracerebral hemorrhage (IGH) treated between January 1989 and December 1997. Glasgow coma scale (GCS) on admission was 15 in 21(50%) patients. The most frequent presenting symptoms were headache in 28 (67%) patients, followed by loss of consciousness in 22(52%) patients and vomiting in 21 (50%) patients. Three cases were diagnosed initially as meningitis and two cases as common cold. The locations of ICH were lobar (26 patients) and cerebellar (7). Cerebral angiographies were performed on 28 patients, and were diagnostic in 19 (68%). Magnetic resonance imaging (MRI) scans revealed two cases of cavernous angiomas, which were confirmed by the pathologic studies of surgical specimens. Laboratory examinations detected two cases of acute leukemia. Four categories of the causes of ICH were determined in 23 (55%) patients. The leading cause of bleeding was arterio venous malformations (AVMs). The in-hospital survival rate of all patients in this study was 79%. Patients with GCS3-5 on admission and ICH located at brain stem, cerebellum, and multiple subcortical areas had higher mortality rates. On the follow-up (mean 42 months), seventy percent of our cases had made a good recovery, 21% a fair recovery, 3% a poor recovery, and 6% had died. Children with ICH recover motor function more rapidly than adults. However, visual deficits always persist at our long-term follow-up examinations. A physician should keep in mind the diagnosis of ICH in children, even though the presenting symptoms may be non-specific and the incidence of ICH is very low in children.

並列關鍵字

intracerebral hemorrhage ； children ； prognosis