Spontaneous intracranial hemorrhage in infants: a clinical analysis of 131 cases

Sha YANG; Xuan ZHAI; Ping LIANG; Yudong ZHOU; Zengpeng YU; Bin ZOU; Wenyuan JI; Jianjun ZHOU

doi:10.16016/j.1000-5404.202003197

您当前的位置：

首页 >

文章列表页 >

Spontaneous intracranial hemorrhage in infants: a clinical analysis of 131 cases

Neurosciences | 更新时间：2026-01-09

- Spontaneous intracranial hemorrhage in infants: a clinical analysis of 131 cases
- Journal of Third Military Medical University Vol. 42, Issue 15, Pages: 1495-1500(2020)
- 作者机构：
  
  400014 重庆，重庆医科大学附属儿童医院神经外科
- 作者简介：
- 基金信息：
  
  the General Program of National Natural Science Foundation of China(81971217)
- DOI：10.16016/j.1000-5404.202003197
  CLC： R181.32;R729;R743.34
- Received：16 March 2020，
  
  Revised：2020-05-13，
  
  Published：15 August 2020
- 稿件说明：
移动端阅览
Sha YANG, Xuan ZHAI, Ping LIANG, et al. Spontaneous intracranial hemorrhage in infants: a clinical analysis of 131 cases[J]. Journal of Third Military Medical University, 2020, 42(15): 1495-1500.
DOI：

Sha YANG, Xuan ZHAI, Ping LIANG, et al. Spontaneous intracranial hemorrhage in infants: a clinical analysis of 131 cases[J]. Journal of Third Military Medical University, 2020, 42(15): 1495-1500. DOI： 10.16016/j.1000-5404.202003197.

摘要

目的

探讨婴幼儿自发性颅内出血的病因、影像学特点、并发症及治疗预后。

方法

回顾性分析2011-2018年我科收治的131例婴幼儿期(≤3岁)自发性颅内出血患儿的临床诊断、影像学检查结果、并发症、治疗方法及预后。

结果

本组患儿的出血病因主要包括晚发型维生素K依赖因子缺乏症72例(54.9%)、动静脉畸形16例(12.2%)、血友病15例(11.4%)、不明原因凝血功能障碍9例(6.9%)、海绵状血管瘤5例(3.8%)、缺氧缺血性脑病4例(3.1%)、脑肿瘤卒中3例(2.3%)、脑型肺吸虫病2例(1.5%)、动脉瘤2例(1.5%)、急性白血病1例(0.8%)，嗜血细胞综合征1例(0.8%)、颅面血管瘤1例(0.8%)。患儿均由CT或MRI检查明确颅内出血诊断，其中34例疑诊脑血管病变者均行CTA检查，检出率为100%。主要并发症包括抽搐或惊厥发作86例(65.6%)、贫血77例(58.8%)、继发感染46例(35.1%)、脑疝32例(24.4%)、脑水肿28例(21.4%)、脑梗塞27例(20.6%)、脑积水26例(19.8%)、呼吸衰竭14例(10.6%)、惊厥持续状态9例(6.9%)。手术治疗43例，非手术治疗88例。预后评估采用GOS评分，预后良好100例(76.3%)。经二元Logistic回归分析结果显示，并发症中脑水肿(

=5.794)、脑疝(

=11.326)和呼吸衰竭(

=8.028)是患儿预后不良的危险因素(

0.05)。

结论

婴幼儿期自发性颅内出血的病因以晚发性维生素K依赖因子缺乏症最常见；出血病因疑诊为脑血管病变者应尽早行CTA检查；并发症以抽搐或惊厥发作最常见；脑水肿、脑疝及呼吸衰竭出现常提示预后不良；该病经积极治疗预后良好。

Abstract

Objective

To explore clinical features of the etiology

imaging characteristics

complications and prognosis of spontaneous intracranial hemorrhage in infants.

Methods

Clinical data of 131 cases of spontaneous intracranial hemorrhage in infants (≤3 years old) admitted to our department from January 2011 to December 2018 were collected and retrospectively analyzed

including their clinical etiology

imaging examination results

complications

treatment methods and prognoses.

Results

The causes of intracranial hemorrhage in this cohort included delayed vitamin K deficiency(72 cases

54.9%)

arteriovenous malformations (16 cases

12.2%)

hemophilia (15 cases

11.4%)

other unexplained coagulation dysfunction (9 cases

6.9%)

cavernous hemangioma (5 cases

3.8%)

hypoxic ischemic encephalopathy (4 cases

3.1%)

brain tumor stroke (3 cases

2.3%)

cerebral paragonimiasis and aneurysm (both 2 cases

1.5%)

and acute leukemia

hemophilic syndrome and

Sturge-Weber syndrome (all 1 case

0.8%). All cases were diagnosed with intracranial hemorrhage by CT scanning or MRI

and for the 34 cases with suspected cerebrovascular disease

the detection rate of CTA was 100%. The complications included convulsion or seizure (86 cases

65.6%)

anemia (77 cases

58.8%)

secondary infections (46 cases

35.1%)

cerebral hernia (32 cases

24.4%)

cerebral edema (28 cases

21.4%)

cerebral infarction (27 cases

20.6%)

hydrocephalus (26 cases

19.8%)

respiratory failure (14 cases

10.6%) and status convulsion (9 cases

6.9%). There were 43 cases undergone surgical treatment

and 88 cases received non-surgical treatment. Glasgow outcome score (GOS) scale indicated that 100 patients (76.3%) achieved a good prognosis. The results of binary logistic regression analysis showed that cerebral edema (

=5.794)

cerebral hernia (

=11.326) and respiratory failure (

=8.028) were risk factors for poor prognosis in the infants with spontaneous intracranial hemorrhage (

0.05).

Conclusion

The most common cause of spontaneous intracranial hemorrhage in infants is delayed vitamin K deficiency. If the cause of hemorrhage is suspected to be cerebrovascular disease

CTA examination should be conducted as early as possible. The most common complications is convulsion or seizure. Cerebral edema

cerebral hernia and respiratory failure often indicate poor prognosis. The disease can obtain a good prognosis after active treatment.

关键词

Keywords

references

MAJERSIK J J, COLE J W, GOL LEDGE J, et al . Recommendations from the international stroke genetics consortium, part 1: standardized phenotypic data collection[J ] . Stroke, 2015, 46(1): 279-284. DOI:10.1161/STROKEAHA.114.006839.

FERRIERO D M, FULLERTON H J, BERNARD T J, et al . Management of stroke in neonates and children: a scientific statement from the American heart association/American stroke association[J ] . Stroke, 2019, 50(3): e51-e96. DOI:10.1161/STR.0000000000000183.

薛辛东.新生儿颅内出血[M]//孙锟, 沈颖.小儿内科学.5版.北京: 人民卫生出版社, 2014: 54-58.

XUE X D. Intracraninal hemorrhage of newborn[M]//SUN K, SHEN Y. Pediatric internal medicine. 5th ed.Beijing: People's Health Press, 2014: 54-58.

LIU J F, WANG D R, LEI C Y, et al . Etiology, clinical characteristics and prognosis of spontaneous intracerebral hemorrhage in children: a prospective cohort study in China[J ] . J Neurol Sci, 2015, 358(1/2): 367-370. DOI:10.1016/j.jns.2015.09.366.

余云湖, 朱涛.儿童期自发性颅内出血85例诊疗分析[J].中华神经外科杂志, 2012, 28(1): 13-16.

YU Y H, ZHU T. Clinical analysis on spontaneous intracerebral hemorrhage in childhood, a report of 85 cases[J]. Chin J Neurosurg, 2012, 28(1): 13-16.

魏中南, 张庆江, 詹江华, 等.晚发性维生素K缺乏性颅内出血外科治疗316例[J].临床小儿外科杂志, 2016, 15(6): 594-597.

WEI Z N, ZHANG Q J, ZHAN J H, et al . Surgical treatment for late vitamin K deficiency intracranial hemorrhage: a report of 316 cases[J ] . J Clin Pediatr Surg, 2016, 15(6): 594-597.

王丽杰, 孙莹, 颜卫源.晚发性维生素K缺乏致颅内出血患儿的临床特征分析[J].中国医科大学学报, 2014, 43(10): 946-949.

WANG L J, SUN Y, YAN W Y. Clinical characteristics of children with late vitamin K deficiency induced intracranial hemorrhage[J]. J China Med Univ, 2014, 43(10): 946-949.

VOLPE J J. Intracranial hemorrhage in early infancy: renewed importance of vitamin K deficiency[J]. Pediatr Neurol, 2014, 50(6): 545-546. DOI:10.1016/j.pediatrneurol.2014.02.017.

OZDEMIR M A, KARAKUKCU M, PER H, et al . Late-type vitamin K deficiency bleeding: experience from 120 patients[J ] . Childs Nerv Syst, 2012, 28(2): 247-251. DOI:10.1007/s00381-011-1575-x.

张英俊, 出良钊, 余晖, 等.四维CT血管造影在脑动静脉畸形诊断中的应用[J].中华神经外科杂志, 2014, 30(9):880-883.DOI:10.3760/cma.j.issn.1001-2346.2014.09.005.

ZHANG Y J, CHU L Z, YU H, et al .Application of 4D-CTA in diagnosis of cerebral arteriovenous malformations[J ] .Chin J Neurosug, 2014, 30(9):880-883.DOI:10.3760/cma.j.issn.1001-2346.2014.09.005.

SUDARSANAM A, ARDERN-HOLMES S L. Sturge-Weber syndrome: from the past to the present[J]. Eur J Paediatr Neurol, 2014, 18(3): 257-266. DOI:10.1016/j.ejpn.2013.10.003.

韩新生, 裘丽红, 许予明.CTA、MRA及DSA在脑血管疾病患者临床诊断中的意义[J].中国实验诊断学, 2014, 18(1):33-36.

HAN X S, QIU L H, XU Y M. Significance of clinical diagnosis with CTA, MRA and DSA in patients with cerebrovascular disease[J]. Chin J Lab Diagn, 2014, 18(1):33-36.

范影, 谢玉海, 李曼曼, 等.单倍剂量三维对比增强MRA诊断脑动静脉畸形的临床价值[J].磁共振成像, 2014, 5(6):455-458.DOI:10.3969/j.issn.1674-8034.2014.06.010.

FAN Y, XIE Y H, LI M M, et al . The clinical value of single-dose three-dimensional contrastenhanced MR angiography in diagnosis of cerebral arteriovenous malformation[J ] . Chin J Magn Reson Imaging, 2014, 5(6):455-458.DOI:10.3969/j.issn.1674-8034.2014.06.010.

王磊, 裴昌军, 王琨, 等.MSCTA在自发性颅内出血病因诊断中的价值[J].中国临床医学影像杂志, 2017, 28(3):162-165.DOI:10.3969/j.issn.1008-1062.2017.03.003.

WANG L, PEI C J, WANG K, et al . The value of MSCTA in the etiological diagnosis of spontaneous intracranial hemorrhage[J ] .J China Clin Med Imaging, 2017, 28(3):162-165.DOI:10.3969/j.issn.1008-1062.2017.03.003.

于军, 王壮, 赵明明, 等.3D-CTA与3D-DSA对颅内动脉瘤诊断价值比较[J].中华神经外科杂志, 2013, 29(3):238-241.DOI:10.3760/cma.j.issn.1001-2346.2013.03.007.

YU J, WANG Z, ZHAO M M, et al . Comparison of the value of 3D-CTA and 3D-DSA in the diagnosis of posterior communicating artery aneurysm[J ] .J China Clin Med Imaging, 2013, 29(3): 238-241.DOI:10.3760/cma.j.issn.1001-2346.2013.03.007.

汪五全, 刘心, 何金年.CTA、MRA诊断脑动静脉畸形:与DSA比较[J].中国介入影像与治疗学, 2012, 9(12): 854-857.

WANG W Q, LIU X, HE J N.Comparison of CTA and MRA with DSA for diagnosis of arteriovenous malformations[J]. Chin J Interv Imaging Ther, 2012, 9(12):854-857.

赵雪灵, 梁平, 翟瑄, 等. 213例儿童自发性颅内出血的临床分析[J].重庆医科大学学报, 2020, 45(1): 134-138. DOI:10.13406/j.cnki.cyxb.002197.

ZHAO X L, LIANG P, ZHAI X, et al .Etiology and clinical features of children with spontaneous intracranial hemorrhage: a clinical analysis[J ] . J Chongqing Med Univ, 2020, 45(1): 134-138. DOI:10.13406/j.cnki.cyxb.002197.

COLE L, DEWEY D, LETOURNEAU N, et al . Clinical characteristics, risk factors, and outcomes associated with neonatal hemorrhagic stroke: a population-based case-control study[J ] . JAMA Pediatr, 2017, 171(3): 230-238. DOI:10.1001/jamapediatrics.2016.4151.

GLASS H C. Neonatal seizures: advances in mechanisms and management[J]. Clin Perinatol, 2014, 41(1): 177-190. DOI:10.1016/j.clp.2013.10.004.

URDAY S, KIMBERLY W T, BESLOW L A, et al . Targeting secondary injury in intracerebral haemorrhage: perihaematomal oedema[J ] . Nat Rev Neurol, 2015, 11(2): 111-122. DOI:10.1038/nrneurol.2014.264.

WANG X, ARIMA H, YANG J, et al . Mannitol and outcome in intracerebral hemorrhage: propensity score and multivariable intensive blood pressure reduction in acute cerebral hemorrhage trial 2 results[J ] . Stroke, 2015, 46(10): 2762-2767. DOI:10.1161/STROKEAHA.115.009357.

LIM-HING K, RINCON F.Secondary hematoma expansion and perihemorrhagic edema after intracerebral hemorrhage:from bench work to practical aspects[J].Front Neurol, 2017, 8:74.DOI:10.3389/fneur.2017.00074.

FOX C K, JOHNSTON S C, SIDNEY S, et al .High critical care usage due to pediatric stroke: results of a population-based study[J ] . Neurology, 2012, 79(5): 420-427.DOI:10.1212/WNL.0b013e3182616fd7.

Views

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

Total colonic aganglionosis in children: clinical manifestations, diagnosis, treatment and outcome

Characteristics of magnetic resonance imaging in refractory hematospermia

Anaplastic large cell lymphoma, lymphohistiocytic variant: report of 2 ALK⁺children and review of literatures

Diagnosis and therapeutic outcome of acute mixed lineage leukemia

Role and mechanism of PSMA4 in prognosis, diagnosis and immune infiltration of lung adenocarcinoma

Related Author

章镇宇

孙静

侯金平

刘清爽

刘伟

李晓庆

王佚

李波军

Related Institution

Department of Breast and Thyroid Surgery， First Affiliated Hospital， Army Medical University （Third Military Medical University）

School of Medicine， Chongqing University

Chongqing Key Laboratory of Precision Prevention and Treatment for Digestive System Tumors， Department of Gastroenterology， Army Medical Center of PLA/Daping Hospital of Third Military Medical University

Department of Gastroenterology， Chongqing Hechuan District People’s Hospital

Department of Hematology, the First Hospital of Lanzhou University

⁰