신생아에서 발생하는 소뇌출혈의 임상양상과 신경학적 예후
The Clinical Characteristics and the Neurodevelopmental Outcomes of the Neonates with Cerebellar Hemorrhage
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목적: 본 연구자들은 14명의 신생아에서 소뇌출혈의 임상양상과 신경학적 예후를 분석하고자 하였다. 방법: 2007년 1월부터 2011년 7월까지 서울대학교 어린이병원과 분당병원 신생아중환아실에 입원했던 환아 중 퇴원을 앞두고 신경계 질환의 평가로 시행한 뇌MRI에서 소뇌출혈이 발견된 12명의 미숙아와 신생아 가사와 산전 초음파검사상 소뇌에 이상소견이 있어 시행한 뇌MRI에서 소뇌출혈이 발견되었던 2명의 만삭아를 포함하여 모두 14명의 신생아의 의무기록을 분석하였다. 결과: 총 14명의 소뇌출혈 환아들 중 10명의 환아들에서는 소뇌출혈이 양측성으로 발생하였고, 3명은 오른쪽, 나머지 한명은 왼쪽에 발생하였다. 6명의 환아(42%)가 Papile III단계 이상의 IVH가 발생하였고, PVL이 6명(42%), PHH도 6명(42%)에서 보였다. 외래 추적관찰을 지속한 소뇌출혈 환아는 12명(85.7%)이었고, 적어도 6개월이 지난 후에 신경학적 평가를 하였다. Papile III단계 이상의 고도 IVH, PVL, PHH 중에 어느 하나라도 있는 신경학적 합병증 동반 군에서는 9명 중 2명(22.2%)에서 뇌성마비가 발생하였고, 5명의 환아가 발달지연으로 진단받았다. 신경학적 합병증 비동반군 5명 중에는 뇌성마비나 발달지연으로 진단받은 경우가 없었다. 결론: 신생아에서의 소뇌출혈은 퇴원을 앞두고 신경계 평가의 일환으로 시행된 brain MRI 검사에서 우연하게 발견되는경우가 많아지고 있다. 고도 IVH, PVL, PHH과 같은 신경학적 합병증이 동반되지 않는 경우에는 뚜렷한 증상이 나타나는 경우가 드물고 신경학적 예후도 그렇게 나쁘지 않을 것으로 추정되나, 소뇌출혈 고유의 신경학적 예후를 알기 위해서는 자료가 더 축적되어야 할 것으로 생각된다.
Abstract
Purpose: We present our experience of 14 neonates with cerebellar hemorrhage and describe the clinical characteristics and the neurodevelopmental outcomes. Methods: Fourteen neonates were identified as having cerebellar hemorrhage, based on the brain MRI findings at the two university hospitals from January 2007 to July 2011. Twelve preterm infants with the brain MRI taken before the discharge, and 2 term infants having taken the brain MRI with birth asphyxia were enrolled. The electronic medical records of the infants were reviewed. Results: Ten (71.4%) infants were found to have multifocal or lobar cerebellar hemorrhage involving both hemispheres. Three infants had unilateral lesions in the right hemisphere, and one infant had a left hemisphere lesion. Six infants (42%) had co-existing high grade IVH (≥grade III); 6 infants (42%) had periventricular leukomalacia (PVL); and 6 infants (42%) had posthemorrhagic hydrocephalus (PHH). After discharge, 12 infants (85.7%) were followed at the outpatient clinics for at least 6 months. Two out of 9 infants (22.2%) with other neurological co-morbidities (IVH≥grade III, PVL, or PHH) had cerebral palsy, and 5 infants (55.6%) had developmental delay assessed by the Bayley scales. None of the infants without other neurological co-morbidities had cerebral palsy or developmental delay. Conclusion: Neonatal cerebellar hemorrhage is often diagnosed incidentally on the brain MRI in the preterm infants. If there is no concomitant high-grade IVH, PVL or PHH, cerebellar hemorrhage seems to hardly accompany its own specific symptoms, and the neurodevelopmental outcomes seem to be favorable as well. However, further long-term, large scale studies are necessary.
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