学龄儿童高血压、间断抽搐1个月

发布时间：2018-03-26 13:30

本文选题：结节性多动脉炎　切入点：高血压　出处：《中国当代儿科杂志》2017年07期

【摘要】：儿童结节多动脉炎(PAN)是一种少见的系统性血管炎,诊治延误可导致后遗症发生率及死亡率增高。该文报道以可逆性后部白质脑病综合征(PRES)起病的儿童结节性多动脉炎1例。患儿,女,10岁,因发现高血压、伴抽搐1个月入院。抽搐前有头痛、呕吐及视物模糊,抽搐表现为全身性发作。入院前半年发现颈部包块。查体血压增高,无中枢神经系统阳性体征。头颅影像学特点为后头部长T1,长T2及FLAIR高信号、DWI等信号,抽搐原因考虑PRES。包块病检提示结节性多动脉炎,无结核依据;超声检查提示右侧肾脏萎缩,肾发射型计算机断层扫描(ECT)提示右肾多发血管狭窄、无血流灌注,确诊为PAN。对于多系统受累的血管疾病,排除常见的血管炎如川崎病及过敏性紫癜后需考虑PAN的可能,尽早行组织病理活检或血管成像检查,争取早期诊断,及早治疗。
[Abstract]:PAN is a rare systemic vasculitis. Delay in diagnosis and treatment may lead to an increase in the incidence and mortality of sequelae. This paper reports a case of nodular polyarteritis in children with reversible posterior leukoencephalopathy syndrome (Pres). He was admitted to hospital for 1 month with convulsions. He had headache, vomiting and blurred vision before convulsion, and the convulsions showed systemic seizures. The neck mass was found in the first half of the year after admission. The body blood pressure was increased. There were no positive signs of central nervous system. The imaging features of the head were T1 of posterior head, long T2 and high signal intensity of FLAIR. The reason of convulsion was PRES.The examination of mass disease showed nodular polyarteritis and no tuberculous evidence, and ultrasound showed atrophy of right kidney. Renal emission computed tomography (PAN) suggested that the right kidney had multiple stenosis, no blood flow perfusion and was diagnosed as PAN.The possibility of PAN should be taken into account after the common vasculitis such as Kawasaki disease and Henoch-Schonlein purpura were excluded. Early histopathological biopsy or angiography, early diagnosis and early treatment.
【作者单位】：遵义医学院附属医院小儿内一科;
【分类号】：R725.4

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