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  [in Japanese] Team Medicine for Pediatric Patients with Cerebral Infarct Caused by Non-Moyamoya Disease  [in Japanese]

Access this Article

Search this Article

Author(s)

    • 安原 隆雄 YASUHARA Takao
    • 岡山大学大学院 脳神経外科 Department of Neurological Surgery, Okayama University Graduate School of Medicine
    • 伊達 勲 DATE Isao
    • 岡山大学大学院 脳神経外科 Department of Neurological Surgery, Okayama University Graduate School of Medicine
    • 杉生 憲志 SUGIU Kenji
    • 岡山大学大学院 脳神経外科 Department of Neurological Surgery, Okayama University Graduate School of Medicine
    • 野坂 宜之 NOSAKA Nobuyuki
    • 岡山大学大学院 小児医学科|岡山大学大学院 救急科 Department of Pediatrics, Okayama University Graduate School of Medicine|Department of Emergency Medicine, Okayama University Graduate School of Medicine

Abstract

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.

Journal

  • Surgery for Cerebral Stroke

    Surgery for Cerebral Stroke 45(6), 476-482, 2017

    The Japanese Society on Surgery for Cerebral Stroke

Codes

  • NII Article ID (NAID)
    130006267751
  • Text Lang
    JPN
  • ISSN
    0914-5508
  • Data Source
    J-STAGE 
Page Top