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Rehabilitation Practice and Science

Translated Title

兒童腦血管疾患病因與復健成效之探討：病例報告

Abstract

The incidence of strokes in childhood is 2.5/100,000. Of these, occlusive stroke accounts for 57 to 85 percent, and hemorrhagic stroke accounts for 15 to 51 percent. Occlusive stroke is primarily caused by congenital heart defects, and the principal symptom is acute hemiplegia. Hemorrhagic stroke is caused mostly by abnormalities of blood vessels, and is characterized by headache and loss of consciousness. Compared to adults, children have better collateral circulation and incompletely developed brains. The clinical and recovery courses those in children are different from those of adults. The prognosis and the incidence of stroke recurrence are largely determined by the etiology of stroke and the degree of severity, so that accurate diagnosis and prevention of causative factors are very important in preventing recurrence of the cerebrovascular disease.The present study explores a case of a five-years-old boy with normal development, presenting with headaches, vomiting, loss of consciousness, and left-side focal seizures and weakness on the right side of the body. The magnetic resonance angiogram showered occlusive stroke to both sides of midbrain, left cerebral peduncle, left pons, and left cerebellum, but no other malformations of blood vessels were noted. The patient underwent multiple tests, including CBC/DC, biochemical analyses, erythrocyte sedimentation rate, PT/APTT, antithrombin III, antinuclear antibodies, cerebrospinal fluid examination, EEG and cardiac sonography, none of which revealed any abnormalities. This patient received rehabilitation and started gait training two months after the onset of illness. He could walk, run, and jump, and gait was almost normal nine months later. Since the patient had moderately, flat feet, pronation control foot orthoses were used for correction. Computer dynography was used to assess balance in walking, with good performance indicated. However, the left limbs still showed a slight degree of uncoordination in motion. The developmental evaluation showed a slight limitation in movement and related abilities, the other mental function and intelligence were normal. The boy made a good recovery, but the cause of the stroke still unknown. Consideration should be given to do urine and blood homocystine tests, and screening for other possible causes such as prothrombin and anticardiolipin antibody tests, PET study for the brain metabolism, or SPECT study for the cerebrovascular circulation. These tests may be useful in discovering the causative factor. It was suggested that the boy return to the clinic for periodic follow-up in order to reduce the likelihood of recurrence.

Language

Traditional Chinese

First Page

235

Last Page

242

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