Öz
Kaynakça
- Yock-Corrales A, Varela-Bulgarelli F, Barboza C, Gutierrez-Mata A, Mackay MT, Babl F. Presentation of Acute childhood stroke in a tertiary pediatric emergency department. Pediatric emergency care. 2018;34:552–7.
- Chadehumbe MA, Khatri P, Khoury JC, Alwell K, Szaflarski JP, Broderick JP, et al. Seizures are common in the acute setting of childhood stroke: a population-based study. Journal of child neurology. 2009;24:9–12.
- van de Port IG, Visser-Meily A, Post MW, Lindeman E. Long-term outcome in children of patients after stroke. Journal of Rehabilitation Medicine. 2008;39:703–7.
- deVeber GA, MacGregor D, Curtis R, Mayank S. Neurologic outcome in survivors of childhood arterial ischemic stroke and sinovenous thrombosis. Journal of child neurology. 2000;15:316–24.
- Bent C, Lee PS, Shen PY, Bang H, Bobinski M. Clinical scoring system may improve yield of head CT of non-trauma emergency department patients. Emergency radiology. 2015;22:511–6.
- Newman-Toker DE, Hsieh Y-H, Camargo Jr CA, Pelletier AJ, Butchy GT, Edlow JA, editors. Spectrum of dizziness visits to US emergency departments: cross-sectional analysis from a nationally representative sample. Mayo Clinic Proceedings; 2008: Elsevier.
- Mirsky DM, Beslow LA, Amlie-Lefond C, Krishnan P, Laughlin S, Lee S, et al. Pathways for neuroimaging of childhood stroke. Pediatric neurology. 2017;69:11–23.
- Mitsunaga MM, Yoon H-C. Journal Club: Head CT scans in the emergency department for syncope and dizziness. American Journal of Roentgenology. 2015;204:24–8.
- Kastrup O, Wanke I, Maschke M. Neuroimaging of infections. NeuroRx. 2005;2:324–32.
- Shellhaas RA, Smith SE, O'Tool E, Licht DJ, Ichord RN. Mimics of childhood stroke: characteristics of a prospective cohort. Pediatrics. 2006;118:704–9.
- Rivkin MJ, deVeber G, Ichord RN, Kirton A, Chan AK, Hovinga CA, et al. Thrombolysis in pediatric stroke study. Stroke. 2015;46:880–5.
- Ladner TR, Mahdi J, Gindville MC, Gordon A, Harris ZL, Crossman K, et al. Pediatric acute stroke protocol activation in a children’s hospital emergency department. Stroke. 2015;46:2328–31.
- Strickberger SA, Benson DW, Biaggioni I, Callans DJ, Cohen MI, Ellenbogen KA, et al. AHA/ACCF scientific statement on the evaluation of syncope: From the American Heart Association councils on clinical cardiology, cardiovascular nursing, cardiovascular disease in the young, and stroke, and the quality of care and outcomes research interdisciplinary working group; and the American College of Cardiology Foundation in collaboration with the Heart Rhythm Society. Journal of the American College of Cardiology. 2006;47:473–84.
- Lynch JK, Hirtz DG, DeVeber G, Nelson KB. Report of the National Institute of Neurological Disorders and Stroke workshop on perinatal and childhood stroke. Pediatrics. 2002;109:116–23.
- Ichord R. Cerebral Sinovenous Thrombosis. Frontiers in pediatrics. 2017;5:163.
Öz
Amaç: Acil serviste akut atipik inme şikayetleri nedeniyle tetkik edilen
hastalarda saptanan patolojileri araştırmak, klinik bulgular ile anormal
nörogörüntüleme bulguları arasındaki ilişkiyi değerlendirmek.
Gereç ve Yöntemler: Çalışmamız hastane etik kurul onayı alınarak yapıldı.
Ocak 2016 ile Ocak 2018 tarihleri arasında, akut atipik inme şikayetleri
nedeniyle beyin bilgisayarlı tomografisi (BT) ve/veya manyetik rezonans (MR) görüntülemesi
yapılmış ardışık 117 hastanın (66 kız, 51 erkek, ortalama yaş 10,9±4,8 yıl), klinik
ve nörogörüntüleme bulguları geriye dönük tarandı. Kategorik ve sayısal
değişkenler Ki-kare, Fisher, t-testi
ile analiz edilerek lojistik regresyon analizi yapıldı.
Bulgular: Hastalarda en sık saptanan şikayetler baş ağrısı (%25,6), kusma (%19,6)
ve bilinç bulanıklığı (%17,9) idi. Hastaların %20,5’inde klinik ile ilişkili vaskülopati,
konjenital afibrinojenemi gibi risk faktörleri saptanırken, %39,3’ünün nörolojik
muayenesi ve %35’inin nörogörüntülemesi anormaldi. On iki hastada klinik ve
nörogörüntüleme bulgularına göre acil tedavi gerektiren patolojiler (akut
arteriyal iskemi [1 hasta], sinovenöz tromboz [1 hasta], intrakraniyal kitle [3
hasta], menenjit [3 hasta], ensefalit [4
hasta]) saptandı. Risk faktörlerinin varlığı, bilinç bulanıklığı ve nörolojik
muayenenin anormal olması ile nörogörüntülemede anormal bulgu saptanması arasında
istatistiksel olarak anlamlı ilişki bulundu (p=0,045). Lojistik
regresyon analizinde anormal nörogörüntüleme bulgularını öngörmede, bilinç bulanıklığı
ve nörolojik muayenenin anormal olması anlamlıydı (p=0,006). MR
görüntüleme (%45,1) ile saptanabilen anormal bulgular BT’ye göre (%17) anlamlı
olarak fazlaydı (p<0.001).
Sonuç: Akut atipik inme şikayetleri ile araştırılan hastalarda, inme dışında
saptanan patolojiler inmeye göre daha sıktı. Hikayesinde klinik ile ilişkili
risk faktörlerine sahip, bilinç bulanıklığı bulunan, nörolojik muayenesi
anormal olan hastalara yapılan nörogörüntülemelerde daha fazla anormallik saptandığı
görüldü.
Anahtar Kelimeler
Kaynakça
- Yock-Corrales A, Varela-Bulgarelli F, Barboza C, Gutierrez-Mata A, Mackay MT, Babl F. Presentation of Acute childhood stroke in a tertiary pediatric emergency department. Pediatric emergency care. 2018;34:552–7.
- Chadehumbe MA, Khatri P, Khoury JC, Alwell K, Szaflarski JP, Broderick JP, et al. Seizures are common in the acute setting of childhood stroke: a population-based study. Journal of child neurology. 2009;24:9–12.
- van de Port IG, Visser-Meily A, Post MW, Lindeman E. Long-term outcome in children of patients after stroke. Journal of Rehabilitation Medicine. 2008;39:703–7.
- deVeber GA, MacGregor D, Curtis R, Mayank S. Neurologic outcome in survivors of childhood arterial ischemic stroke and sinovenous thrombosis. Journal of child neurology. 2000;15:316–24.
- Bent C, Lee PS, Shen PY, Bang H, Bobinski M. Clinical scoring system may improve yield of head CT of non-trauma emergency department patients. Emergency radiology. 2015;22:511–6.
- Newman-Toker DE, Hsieh Y-H, Camargo Jr CA, Pelletier AJ, Butchy GT, Edlow JA, editors. Spectrum of dizziness visits to US emergency departments: cross-sectional analysis from a nationally representative sample. Mayo Clinic Proceedings; 2008: Elsevier.
- Mirsky DM, Beslow LA, Amlie-Lefond C, Krishnan P, Laughlin S, Lee S, et al. Pathways for neuroimaging of childhood stroke. Pediatric neurology. 2017;69:11–23.
- Mitsunaga MM, Yoon H-C. Journal Club: Head CT scans in the emergency department for syncope and dizziness. American Journal of Roentgenology. 2015;204:24–8.
- Kastrup O, Wanke I, Maschke M. Neuroimaging of infections. NeuroRx. 2005;2:324–32.
- Shellhaas RA, Smith SE, O'Tool E, Licht DJ, Ichord RN. Mimics of childhood stroke: characteristics of a prospective cohort. Pediatrics. 2006;118:704–9.
- Rivkin MJ, deVeber G, Ichord RN, Kirton A, Chan AK, Hovinga CA, et al. Thrombolysis in pediatric stroke study. Stroke. 2015;46:880–5.
- Ladner TR, Mahdi J, Gindville MC, Gordon A, Harris ZL, Crossman K, et al. Pediatric acute stroke protocol activation in a children’s hospital emergency department. Stroke. 2015;46:2328–31.
- Strickberger SA, Benson DW, Biaggioni I, Callans DJ, Cohen MI, Ellenbogen KA, et al. AHA/ACCF scientific statement on the evaluation of syncope: From the American Heart Association councils on clinical cardiology, cardiovascular nursing, cardiovascular disease in the young, and stroke, and the quality of care and outcomes research interdisciplinary working group; and the American College of Cardiology Foundation in collaboration with the Heart Rhythm Society. Journal of the American College of Cardiology. 2006;47:473–84.
- Lynch JK, Hirtz DG, DeVeber G, Nelson KB. Report of the National Institute of Neurological Disorders and Stroke workshop on perinatal and childhood stroke. Pediatrics. 2002;109:116–23.
- Ichord R. Cerebral Sinovenous Thrombosis. Frontiers in pediatrics. 2017;5:163.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | İç Hastalıkları |
| Bölüm | ORIGINAL ARTICLES |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Temmuz 2019 |
| Gönderilme Tarihi | 13 Şubat 2019 |
| Yayımlandığı Sayı | Yıl 2019 Cilt: 13 Sayı: 4 |
