신생아 뇌졸중의 임상적 양상에 관한 연구
Clinical Spectrum of Neonatal Strokes
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목 적:신생아에서 뇌졸중은 다른 소아연령에 비해 비교적 흔하나 이에 대한 임상양상에 대한 연구는 제한적이다. 본 연구는 신생아 뇌졸중 환자의 임상양상 및 신경학적 결과에 전반에 대해 알아보고자 실시하였다. 방 법:2000년 1월부터 2009년 12월까지 경북대학교병원에서 신생아 뇌졸중으로 진단된 27명의 환자를 대상으로 의무기록을 근거로 후향적 분석하였다. 결 과:27명 환자의 평균 나이는 4±5.6일이었으며, 제태주수는 만삭아가 16명, 미숙아가 9명, 과숙아가 2명이었으며 저체중아는 6명이 있었다. 증상발현 시점은 생후 1일 이내가 14명(51.9%)로 가장 많았고 생후 7일이내가 23명(85.2%)으로 대부분을 차지하였다. 첫 증상으로 경련이 11명(40.7 %)으로 가장 많았으며, 경련의 양상은 국소성간대발작과 다국소간대발작이 각각 5명(38.5%)으로 주된 양상을 보였다. 뇌파를 시행한 12명의 환자들 중 9명(75%)이 이상뇌파 소견을 보였고 영상의학적 소견으로 경막밑 출혈 13례, 뇌실 내 출혈이 7례, 뇌실밑 출혈 4례, 대뇌 실질 내 출혈 3례, 뇌경색 3례 등이 관찰되었다. 신경학적 예후는 추적 관찰한 12명 중 경증의 장애가 4명, 중증의 장애가 2명이 있었다. 결 론:본 연구에서 신생아 뇌졸중의 첫 증상 발현 시점은 대개 생후 첫 1주일 이내이며, 국소경련이 주된 증상이었다. 따라서 생후 첫 1주일이내에 경련을 보이는 환자에서는 신생아 뇌졸중을 염두해두고 뇌 초음파나 뇌 자기공명영상 검사를 반드시 시행해야 할 것으로 생각된다.
Abstract
Purpose:Neonatal strokes are common and may be associated with various complications. However, few studies have been conducted on the clinical spectrum in Korea. This study aimed at investigating the clinical presentation and neurological outcome of neonatal strokes. Methods:Twenty-seven neonates with neonatal stroke were enrolled in the neonatal intensive care unit at Kyungpook National University Hospital from January 2000 to December 2009. Their medical records and neuroradiological findings were retrospectively reviewed. Results:The mean age of the subjects was 4±5.6 days. Sixteen patients were full term, nine were prematurite and six had low birth weights. The onset of symptoms was mostly within first week (85.2%) of life, especially in the first day of life (51.9 %). The most common symptom was seizure (40.7%), which were focal clonic (38.5 %) or multifocal clonic (38.5%). Nine patients showed abnormal EEG findings. Thirteen patients had subdural hemorrhage, seven showed intraventricular hemorrhage, and three revealed cerebral infarction. Among 12 patients who followed-up for one year, four had mild neurologic dysfunction and two had severe impairment. Conclusion:We found that the onset of symptom in neonatal strokes was mostly within the first day of life, and the most common symptom was focal seizure. We, therefore recommend that neuroimaging be done when newborns have seizures within their first week of life. However, further studies are needed to elucidate this further.
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