小儿蛛网膜下腔出血的血管痉挛。

Ioannis Mavridis, Efstratios-Stylianos Pyrgelis, Eleni Agapiou, Jeries Assi
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摘要

脑血管痉挛(CV)是蛛网膜下腔出血(SAH)的常见严重并发症,SAH是一种在儿童中罕见的严重颅内出血类型。本文的目的是回顾目前关于这种潜在的破坏性并发症的文献。CV可能是无症状的,与成人相比,在儿童中较少见。包括炎症在内的一些分子现象有助于其病理生理。小儿侧支循环好,脑血流量高是保护因素。当临床表现明显时,CV可能表现为儿童神经状态或生命体征的改变。CV可通过脑血管造影诊断,如计算机断层血管造影、磁共振血管造影、数字减影血管造影、经颅多普勒超声、计算机断层灌注等。动脉直径减小< 50%证实了诊断。除了一般的支持措施和SAH的病因治疗外,心血管治疗的选择包括钙通道阻滞剂和神经介入方法,如动脉内血管扩张剂和球囊血管成形术。儿童的长期结果通常是有利的。
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Vasospasm in Pediatric Subarachnoid Hemorrhage.

Cerebral vasospasm (CV) is a common severe complication of subarachnoid hemorrhage (SAH), a severe type of intracranial bleeding that is uncommon in children. The purpose of this article is to review the current literature regarding this potentially devastating complication. CV may be asymptomatic and is less common in children compared to adults. Several molecular phenomena, including inflammatory ones, contribute to its pathophysiology. Better collateral circulation and higher cerebral blood flow are protective factors in children. When clinically apparent, CV may manifest as a change in the child's neurologic status or vital signs. CV can be diagnosed using brain vessel imaging, such as computed tomography angiography, magnetic resonance angiography, digital subtraction angiography, transcranial Doppler ultrasonography, and computed tomography perfusion. A reduction of < 50% in the artery's caliber confirms the diagnosis. Besides general supportive measures and causative treatment of SAH, CV management options include the administration of calcium channel blockers and neurointerventional approaches, such as intra-arterial vasodilators and balloon angioplasty. Long-term outcomes in children are usually favorable.

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