非もやもや病小児脳梗塞・脳虚血症例の治療におけるチーム医療の重要性

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  • Team Medicine for Pediatric Patients with Cerebral Infarct Caused by Non-Moyamoya Disease

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Introduction: Pediatric cerebral infarct is rare and sometimes difficult to diagnose and treat correctly. In this article, we report 4 cases of pediatric cerebral infarct caused by non-moyamoya disease, and discuss problems in the treatment and the specialties involved in care.<br>Case Presentation:〈Case 1〉 A 9-year-old girl developed left hemiparesis and was diagnosed with a cerebral infarct in the right internal capsule. She was treated with aspirin for 20 months without recurrence.<br>〈Case 2〉 A 13-year-old boy developed altered consciousness and was admitted to another hospital. Right carotid artery occlusion and stenosis of the left carotid artery and renal artery were diagnosed. He was treated with steroid and heparin for arteritis. At 3 days after onset, he was transferred to our hospital and underwent external decompression for cerebral infarcts in the right middle cerebral artery territory 5 days after onset. After cranioplasty, he was in status epilepticus and required barbiturate coma for 2 weeks. At 5 months after cranioplasty, he was transferred to the rehabilitation hospital for gait training.<br>〈Case 3〉 A 10-month-old girl developed left hemiparesis and was transferred to our hospital 3 days later. She was diagnosed with a cerebral infarct in the right putamen with agenesis of the carotid artery. She experienced cerebral infarcts twice and was finally diagnosed with embolic infarcts. She was treated with warfarin and aspirin for 12 months without recurrence.<br>〈Case 4〉 A 2-year-old girl with Klippel-Trenaunay syndrome had recurrent left hemiparesis and epilepsy. She was diagnosed with right carotid artery occlusion and was treated with aspirin for 12 months without recurrence.<br>Results: All 4 patients received medication and rehabilitation with subsequent functional recovery, although Case 2 underwent external decompression 5 days after onset. Team medical care involving the departments of Emergency Medicine, Pediatrics, Pediatric Neurology, and Neurological Surgery were needed for all patients. Mental health care was needed for both the patients and their patients.<br>Conclusion: There is no standard evidence-based treatment for pediatric cerebral infarct. The diagnosis and treatment are difficult. Individualized therapy is required because of unexpected complications. Team medicine involving multiple departments is needed for pediatric cerebral infarct.

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  • 脳卒中の外科

    脳卒中の外科 45 (6), 476-482, 2017

    一般社団法人 日本脳卒中の外科学会

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