소아 허혈성 뇌졸중의 신경학적 예후: 단일 기관 연구
Neurological Outcome of Ischemic Stroke in Children: a Single Center Study
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목적: 허혈성 뇌졸중은 소아에서 드물게 발생하는 질환이지만 심각하게는 사망을 초래하고 운동마비, 인지장애, 뇌전증 등과 같은 발달장애를 남길 수 있어 임상적 중요성이 강조되고 있다. 본 연구에서는 소아 허혈성 뇌졸중의 신경학적 예후를 조사하였으며 예후와 연관성이 있는 요인을 찾아 보고자 하였다. 방법: 2006년 1월부터 2016년 12월까지 전남대학교병원 소아청소년과에서 허혈성 뇌졸중으로 진단 받았던 15세 미만 환자들을 대상으로 의무기록을 후향적으로 조사하였다. 결과: 대상 환자 총 38명 중 남자가 18명(47.4%), 여자가 20명(52.6%)이었고 평균 연령은 6세 1개월±4세 8개월이었다. 특발성 허혈성 뇌졸중이 14명(36.8%)으로 가장 많았고 허혈성 뇌졸중의 원인으로 모야모야병, 수막염, 급성 심근염, 급성 림프구성 백혈병, 패혈증, 외상 등이 있었다. 허혈성 뇌졸중 발병 후 2주 이내 초기 경련이 19명(50.0%)에서 나타났고 이 중 14명(73.7%)은 부분 경련을, 5명(26.3%) 은 전신 경련을 보였다. 뇌자기공명영상 검사에서 15명(39.5%)은 좌뇌에, 16명(42.1%)은 우뇌에 병변을 보였으며 26명(68.4%)에서 하나의 병변이, 12명(31.6%)에서 여러 개의 병변이 관찰되었다. 허혈성 뇌졸중 발병 후 2주 이내에 33명(86.8%)에서 뇌파 검사를 시행하였고이 중 21명(63.6%)에서 이상 뇌파가 관찰되었다. 1년 이상 추적 관찰하여 신경학적 예후를 조사하였고 신경학적 장애가 남지 않은 환자는 10명(26.3%)이었으며 운동마비가 22명(57.9%), 인지장애가 9명(23.7%), 뇌전증이 20명(52.6%)에서 나타났다. 연령, 성별, 초기 경련, 병변의 특성, 이상 뇌파 중 각 신경학적 장애와 연관성이 있는 요인을분석하여 보았을 때 인지장애와 연관성이 있는 요인으로는 이상 뇌파가 있었고(P 값=0.026) 뇌전증과 연관성이 있는 요인으로는 초기 경련이 있었다(P 값=0.000). 결론: 소아 허혈성 뇌졸중 발병 1년 후 73.7%에서 신경학적 장애가남았다. 인지장애는 허혈성 뇌졸중 발병 후 2주 이내에 보였던 이상뇌파와 연관성이 있었으며 뇌전증은 초기 경련의 발생과 연관성이 있었다.
Abstract
Purpose: Ischemic stroke is rarely seen in children, but it could cause mortality and result in developmental disabilities such as motor paralysis, cognitive dysfunction, and epilepsy. In this study, the neurological outcomes of ischemic stroke in children were reviewed and the factors associated with the neurological outcomes were to be analyzed. Methods: Medical records of patients younger than 15 years of age who were newly diagnosed with ischemic stroke between January 2006 and December 2016 in Chonnam National University Hospital were reviewed. Results: This study consisted of 38 patients with ischemic stroke (male/female= 18/20, mean age=6 years 1 month±4 years 8 months). Neurological outcomes assessment was done at least 1 year after the onset of ischemic stroke. 10 patients (26.3%) had no neurological impairments. Motor paralysis was noted in 22 (57.9%), cognitive dysfunction was in 9 (23.7%), and epilepsy in 20 (52.6%). Among the possible risk factors for neurological impairments (age, sex, early seizures, characteristics of the infarcted lesions, abnormal electroencephalogram (EEG) findings), abnormalities on EEG findings were significantly associated with cognitive dysfunction (P=0.026) and the occurrence of early seizures with epilepsy (P=0.000). Conclusion: Neurological impairments were remained in 73.7% of children one year after ischemic stroke. Cognitive dysfunction was associated with abnormalities on EEG findings within 2 weeks after the onset of ischemic stroke and epilepsy with the occurrence of early seizures.
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