Hafif Kafa Travması Sonrası Bazal Ganglion İnternal Kapsülada (BGİK) İnme Gelişen İki Olgu

Yıl 2022, Cilt: 9 Sayı: 2, 341 - 345, 30.06.2022

Sibğatullah Ali Orak , Celil Yılmaz , Çisil Çerçi Kubur , Aslı Kübra Atasever , Muzaffer Polat

https://doi.org/10.34087/cbusbed.999004

Öz

Çocuklarda inme beyin tümörleri kadar sıktır ve çocukluk çağında ilk on ölüm nedeni arasındadır. Kafa travması geçiren çocuklarda, hemorojik inme, iskemik inmeye göre daha sık görülmektedir. Hafif kafa travması sonrası 2 yaş altı çocuklarda beynin anatomik özellikleri ve mekanik vazospazm gibi mekanizmalarla açıklanmaya çalışılan lentikülostriat inme sık bildirilmektedir. Aileler ve hekimler tarafından çoğunlukla önemsenmeyen hafif kafa travmaların her zaman masum olmadığını dikkat çekmek amacıyla acil servisimize ve nöroloji polikliniğimize kısa zaman aralıkları ile başvuran iki yaş altındaki 2 olguyu sunduk. Sunulan olgularda sonuç olarak iskemik inmenin travma sonrası geç klinik bulgu göstermesi ve/veya hafif klinik bulgularla başvurması nedeniyle 2 yaş altı çocuklarda iyi bir anamnez, dikkatli nörolojik muayenenin yanında mutlaka diffüzyon ağırlıklı MR görüntüleme tetkikleri ile ayrıntılı olarak değerlendirilmesi yargısına ulaştık.

Anahtar Kelimeler

İnme, Travma, Çocuk, İskemi, Lentikülostriat

Two Cases Developed Stroke in the Basal Ganglion Internal Capsule (BGIC) After Mild Head Trauma

Öz

Strokes in children are as common as brain tumors and are among the top ten causes of death in childhood. Hemorrhagic stroke is more common in children with head trauma than ischemic stroke. Lenticulostriate stroke, which has tried to be explained by mechanisms such as anatomical features of the brain and mechanical vasospasm, is frequently reported in children under two years of age after mild head trauma. To draw attention to the fact that mild head injuries, which are often disregarded by families and physicians, are not always innocent, we discussed two cases under the age of two referred to our emergency department and neurology outpatient clinic in short time intervals.In conclusion, we determined that ischemic stroke tends to show late clinical findings after trauma and/or presents with mild clinical findings in children under 2 years of age. So approaching head trauma requires with a well-questioned anamnesis, careful neurological examination with diffusion-weighted MRI examinations.

Anahtar Kelimeler

stroke, trauma, child, ischemia, lenticulostriate

Kaynakça

• 1.Bektaş Ö, Teber S, Deda G. İnme ve Serebrovasküler Hastalıklar. Türkiye Klinikleri J Pediatr. 2018, 14(1):148-163.
• 2.Lynch JK, Hirtz DG, DeVeber G, Nelson KB Report of the national institute of neurological disorders and stroke workshop on perinatal and childhood stroke. Pediatrics. 2002, 109:116–123.
• 3.L. Shaffer, P. M. Rich, K. R. E. Pohl, and V. Ganesan, “Canmild head injury cause ischaemic stroke?” Archives of Disease in Childhood. 2003,vol. 88, no. 3, pp. 267–269.
• 4.Wang G, Luan Y, Feng L, Yu J. Current status of infarction in the basal ganglia-internal capsule due to mild head injury in children using PRISMA guidelines. Exp Ther Med. 2020, Feb; 19(2): 1149–1154.
• 5.Nabika S, Kiya K, Satoh H, Mizoue T, Oshita J and Kondo H: Ischemia of the internal capsule due to mild head injury in a child. Pediatr Neurosurg .2007, 43: 312‑315.
• 6.Kieslich M, Fiedler A, Heller C, Kreuz W and Jacobi G: Minor head injury as cause and co‑factor in the aetiology of stroke in childhood: A report of eight cases. J Neurol Neurosurg Psychiatry.2002, 73: 13‑16.
• 7.Provenzale JM and Sorensen AG: Diffusion‑weighted MR imaging in acute stroke: Theoretic considerations and clinical applications. AJR Am J Roentgenol.1999, 173: 1459‑1467. 8.Dharker SR, Mittal RS and Bhargava N: Ischemic lesions in basal ganglia in children after minor head injury. Neurosurgery.1993, 33: 863‑865.
• 9.Ahn JY, Han IB, Chung YS, Yoon PH and Kim SH: Posttraumatic infarction in the territory supplied by the lateral lenticulostriate artery after minor head injury. Childs Nerv Syst. 2006, 22: 1493‑1496.
• 10.Jain P, Kishore P, Bhasin JS and Arya SC: Mineralizing angiopathy with basal ganglia stroke in an infant. Ann Indian Acad Neurol. 2015, 18: 233‑234.
• 11.Yang FH, Wang H, Zhang JM and Liang HY: Clinical features and risk factors of cerebral infarction after mild head trauma under 18 months of age. Pediatr Neurol. 2013, 48: 220‑226.
• 12.Lingappa L, Varma RD, Siddaiahgari S, et al. Mineralizing angiopathy with infantile basal ganglia stroke after minor trauma. Dev Med Child Neurol. 2014, 56:78–84.
• 13.Marinkovic SV, Milisavljevic MM, Kovacevic MS and Stevic ZD: Perforating branches of the middle cerebral artery. Microanatomy and clinical significance of their intracerebral segments. Stroke. 1985, 16: 1022‑1029.
• 14.Rana KS, Behera MK and Adhikari KM: Ischemic strokefollowing mild head injury is it the cause. Indian Pediatr. 2006, 43: 994‑997.
• 15.Donzelli R, Marinkovic S, Brigante L, de Divitiis O, Nikodijevic I, Schonauer C and Maiuri F: Territories of the perforating (lenticulostriate) branches of the middle cerebral artery. Surg Radiol Anat. 1998, 20: 393‑398.
• 16.Rafay MF, Pontigon AM, Chiang J, et al. Delay to diagnosis in acute pediatric arterial ischemic stroke. Stroke. 2009, 40:58-64.
• 17.McGlennan C, Ganesan V. Delays in investigation and management of acute arterial ischaemic stroke in children. Dev Med Child Neurol.2008, 50:537–540.
• 18.Manus J. Donahue, Nomazulu Dlamini Aashim Bhatia, and Lori C. Jordan, Neuroimaging advances in pediatric stroke. Stroke.2019, 50(2): 240–248.
• 19.Marks MP, de Crespigny A, Lentz D, Enzmann DR, Albers GW, Moseley ME. Acute and chronic stroke: navigated spin-echo diffusion-weighted MR imaging. Radiology. 1996, 199:403– 408.
• 20.Gonzalez RG, Schaefer PW, Buonanno FS, et al. Diffusion-weighted MR imaging: diagnostic accuracy in patients imaged within 6 hours of stroke symptom onset. Radiology. 2019, 210:155–162.
• 21.Lovblad KO, Laubach HJ, Baird AE, et al. Clinical experience with diffusion-weighted MR in patients with acute stroke. AJNR Am J Neuroradiol 1998, 19:1061–1066,1998