兒童動脈缺血性腦中風之復健成效及預後：病例報告

Rehabilitation and Prognosis of Childhood Arterial Ischemic Stroke: A Case Report

戴家煌(Chia-Huang Dai) ； 顏威彰(Wei-Jang Yen) ； 官大紳(Ta-Shen Kuan) ； 洪章仁(Chang-Zern Hong)

《台灣復健醫學雜誌》 36卷2期 (2008/06) Pp. 105-110

https://doi.org/10.6315/2008.36(2)05

摘要

兒童缺血性腦中風根據國外文獻指出發生率每年每十萬兒童有2-13例，儘管發生率明顯較成人腦中風爲低，兒童腦中風仍會造成顯著的功能障礙，甚至死亡。由於個案數目少，目前針對兒童缺血性腦中風的治療多根據個案報告，或依成人腦中風治療經驗加以調整。
本文所報告的是一位十一歲八個月大的男童，頭暈、嘔吐三天後，在學校突然發生右側肢體無力、步態不穩以及說話不清楚的症狀，兩天後病患右側肢體肌力從四分下降至一分，經由腦部磁振造影證實是左側大腦內囊(internal capsule)阻塞，同時發現左側中大腦動脈末梢分枝細小及後交通枝(posterior communicating artery)發育不良。經抗凝血劑與輸液治療之後，神經學症狀穩定，無持續惡化現象。之後病患接受復健治療半年，步態與右側肢體肌力皆趨於正常。利用魏氏智力量表第三版評估總智商爲82，雖略爲偏低，病患於學校中的課業表現尚可接受。
過去曾有觀念認爲兒童腦中風的功能預後較成人更好，然而此一觀念未有足夠的證據支持，反而有越來越多的研究顯示兒童腦中風後有仍會遺留有顯著的運動、認知及語言功能障礙。本文藉此病例探討兒童動脈缺血性腦中風之病因及復健成效，並與相關文獻比較。

關鍵字

兒童 ； 動脈缺血性中風 ； 半側偏癱

並列摘要

The incidence of ischemic stroke in childhood is two to 13 per 100,000 children per year. Although the incidence is much lower than adults, strokes in children not only cause a large number of deaths, but also induce significant disabilities. Because childhood ischemic strokes are rare, multi center, controlled trials should be performed to provide evidence based data related to effectiveness of medical treatment and rehabilitation. Current studies on the management of stroke in children are mainly based on case reports, uncontrolled trials, or are adapted from adult literature.
An eleven-year-old, obese boy presented to the Emergency Department with an initial presentation of sudden onset right sided limb weakness, unsteady gait, and slurred speech. Muscle strength on the right side was grade Ⅳ, but rapidly decreased to grade Ⅰ over the following two days. Brain MRI revealed left internal capsule infarct. No other etiological or risk factors could be identified.
The boy received treatment with oral aspirin. Low molecular weight heparin injection was also given for ten days. No significant side effects occurred during the treatment. A comprehensive rehabilitation program started on the tenth day after stroke onset. After comprehensive rehabilitation for 6 months, the patient's gait pattern and muscle strength recovered to near normal. Recovery of motor function was quite remarkable. His intelligence measured by WISC-Ⅲ indicated that his total IQ was 82. Although the IQ level was in the range of the lower normal limit, the boy returned to his original school, and had fair academic performance.
Previously it was thought that children with strokes recover better than adults due to a higher development potential of the immature brain, but this concept was not evidence based. An increasing number of studies have analyzed motor, cognitive and behavior impairments after stroke in childhood. This article discusses the etiology, specific medical treatment, rehabilitation and prognosis of arterial ischemic stroke in childhood. Related articles were also reviewed and compared to our case.

並列關鍵字

children ； arterial ischemic stroke ； hemiplegia