급성 심근염을 치료중이던 영아에서 발생한 뇌경색 -증례 보고-
Cerebral Ischemic Stroke in an Infant with Acute Myocarditis - A Case Report -
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A 9-month-old infant presented with cough, tachypnea, and grunting was admitted. The patient was revealed to have cardiomegaly, high NT-proBNP, and severe left ventricular dilation and dysfunction; she was subsequently diagnosed with acute myocarditis and congestive heart failure. Intravenous immunoglobulin, inotropics, diuretics, angiotensin converting enzyme inhibitors and beta blocker were used. However, left hemiparesis suddenly developed at 30-day after treatment. Brain MRI showed high signal intensity in the right middle cerebral arterial territory on diffusion weighted brain MRI and in the left parietal lobe with gyral enhancement. Echocardiogram revealed no definite intraventricular thrombus. The patient was started on an antiplatelet agent only without anticoagulant therapy for the treatment of cerebral infarct in respect of the risk to the infant. Four years after the cerebral ischemic stroke (CIS), she showed complete recovery from hemiparesis, with no more CIS. In conclusion, severe ventricular dilatation and dysfunction can lead to thromboembolic events in infants. We should keep in mind that anticoagulant or antiplatelet agents can be used in specific situations.
Abstract
A 9-month-old infant presented with cough, tachypnea, and grunting was admitted. The patient was revealed to have cardiomegaly, high NT-proBNP, and severe left ventricular dilation and dysfunction; she was subsequently diagnosed with acute myocarditis and congestive heart failure. Intravenous immunoglobulin, inotropics, diuretics, angiotensin converting enzyme inhibitors and beta blocker were used. However, left hemiparesis suddenly developed at 30-day after treatment. Brain MRI showed high signal intensity in the right middle cerebral arterial territory on diffusion weighted brain MRI and in the left parietal lobe with gyral enhancement. Echocardiogram revealed no definite intraventricular thrombus. The patient was started on an antiplatelet agent only without anticoagulant therapy for the treatment of cerebral infarct in respect of the risk to the infant. Four years after the cerebral ischemic stroke (CIS), she showed complete recovery from hemiparesis, with no more CIS. In conclusion, severe ventricular dilatation and dysfunction can lead to thromboembolic events in infants. We should keep in mind that anticoagulant or antiplatelet agents can be used in specific situations.
참고문헌 (14)
- Ganesan V, "Investigation of risk factors in children with arterial ischemic stroke", Ann Neurol, 53, pp.167~173 (2003)
- Fullerton HJ, "Risk of recurrent childhood arterial ischemic stroke in a populationbased cohort: the importance of cerebrovascular imaging", Pediatrics, 119, pp.495~501 (2007)
- deVeber G, "Stroke and the child's brain: an overview of epidemiology, syndromes and risk factors", Curr Opin Neurol, 15, pp.133~138 (2002)
- Danchaivijitr N, "Evolution of cerebral arteriopathies in childhood arterial ischemic stroke", Ann Neurol, 590, pp.620~626 (2006)
- Monagle P, "American College of Chest Physicians. Antithrombotic therapy in neonates and children: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines", Chest, 141(2 Suppl), pp.e737S~e801S (2012)
- Magnani JW, "Myocarditis: current trends in diagnosis and treatment", Circulation, 113, pp.876~890 (2006)
- Lewis AB, "Outcome of infants and children with dilated cardiomyopathy", Am J Cardiol, 68, pp.365~369 (1991)
- Matitiau A, "Infantile dilated cardiomyopathy. Relation of outcome to left ventricular mechanics, hemodynamics, and histology at the time of presentation", Circulation, 90, pp.1310~1318 (1994)
- Falk RH, "Ventricular thrombi and thromboembolism in dilated cardiomyopathy: a prospective follow- up study", Am Heart J, 123, pp.136~142 (1992)
- Kalaria VG, "Effect of mitral regurgitation on left ventricular thrombus formation in dilated cardiomyopathy", Am Heart J, 135, pp.215~220 (1998)
- Yamamoto K, "The coagulation system is activated in idiopathic cardiomyopathy", J Am Coll Cardiol, 25, pp.1634~1640 (1995)
- Furie KL, "American Heart Association Stroke Council, Council on Cardiovascular Nursing, Council on Clinical Cardiology, and Interdisciplinary Council on Quality of Care and Outcomes Research: Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: a guideline for healthcare professionals from the american heart association", american stroke association, 2011, pp.42, 227~276
- Günthard J, "Dilated cardiomyopathy and thrombo-embolism", Eur J Pediatr, 156, pp.3~6 (1997)
- McCrindle BW, "Presentation, management and outcomes of thrombosis for children with cardiomyopathy", Can J Cardiol, 22, pp.685~690 (2006)