Infarto estriatocapsular na infância: relato de quatro casos

Leboreiro-Fernandez, A.; Leboreiro, I.E.F.; Moura-Ribeiro, M.V.L.

doi:10.1590/S0004-282X1994000300018

Resumos

Os autores apresentam o estudo de quatro crianças que manifestaram hemiparesia desproporcionada de instalação súbita, sem perda da consciência. O diagnóstico de infarto estriatocapsular foi confirmado pela tomografia computadorizada do crânio (TCC) e ressonância magnética (RM). Discutem os achados clínico-neurológicos e de exames complementares. História familiar de migrânea foi relatada em dois dos pacientes. Constatou-se migrânea em dois, trauma craniano, miocardite e prolapso de válvula mitral em um. Hemiparesia esquerda, com predomínio bráquio-facial em três e braquial em um. A TCC demonstrou comprometimento do núcleo lenticular e da cápsula interna nos quatro casos; da cabeça do núcleo caudado em três e da substância branca em dois. A RM foi realizada em dois e confirmou os achados da TCC. O eletrencefalograma, obtido na fase aguda em três, se mostrou alterado nos quatro casos.

infarto estriatocapsular; isquemia cerebral; hemiplegia aguda; infância

The authors present the study of four children that manifested asymmetric hemiparesis with sudden onset, without consciousness loss. The diagnosis of striatocapsular infarction was confirmed by computed tomography (CT) and magnetic resonance imaging (MRI). The clinical and neurological examination, and laboratorial results are discussed. Familial history of migraine was found in two of the patients. Migraine was diagnosed in two, mild head trauma, viral miocarditis and mitral valve prolapse in one. Left hemiparesis, with brachiofacial features in three, and brachial in one. CT showed lenticular nucleus and internal capsule lesions in all of them, head of caudate nucleus in three, and white substance in two. MRI was done in two and confirmed CT findings. Electroencephalogram, at the acute phase in three, showed abnormalities in all patients.

striatocapsular infarction; cerebral ischemia; acute hemiplegia; childhood

Infarto estriatocapsular na infância: relato de quatro casos

Striatocapsular infarction in childhood: report of four cases

A. Leboreiro-Fernandez^I; I.E.F. Leboreiro^II; M.V.L. Moura-Ribeiro^III

^IProfessor Colaborador da Disciplina de Neurologia do Hospital Escola da Faculdade de Medicina do Triângulo Mineiro (FMTM); Pós-graduando do Departamento de Neuropsiquiatria e Psicologia Médica da Faculdade de Medicina de Ribeirão Preto, USP

^IICardiologista da Seção de Eletrocardiografía e Intensivista do Hospital Escola da FMTM

^IIIProfessor Associado do Departamento de Neurologia da Faculdade de Ciências Médicas, UNICAMP

RESUMO

Os autores apresentam o estudo de quatro crianças que manifestaram hemiparesia desproporcionada de instalação súbita, sem perda da consciência. O diagnóstico de infarto estriatocapsular foi confirmado pela tomografia computadorizada do crânio (TCC) e ressonância magnética (RM). Discutem os achados clínico-neurológicos e de exames complementares. História familiar de migrânea foi relatada em dois dos pacientes. Constatou-se migrânea em dois, trauma craniano, miocardite e prolapso de válvula mitral em um. Hemiparesia esquerda, com predomínio bráquio-facial em três e braquial em um. A TCC demonstrou comprometimento do núcleo lenticular e da cápsula interna nos quatro casos; da cabeça do núcleo caudado em três e da substância branca em dois. A RM foi realizada em dois e confirmou os achados da TCC. O eletrencefalograma, obtido na fase aguda em três, se mostrou alterado nos quatro casos.

Palavras-chave: infarto estriatocapsular, isquemia cerebral, hemiplegia aguda, infância.

SUMMARY

The authors present the study of four children that manifested asymmetric hemiparesis with sudden onset, without consciousness loss. The diagnosis of striatocapsular infarction was confirmed by computed tomography (CT) and magnetic resonance imaging (MRI). The clinical and neurological examination, and laboratorial results are discussed. Familial history of migraine was found in two of the patients. Migraine was diagnosed in two, mild head trauma, viral miocarditis and mitral valve prolapse in one. Left hemiparesis, with brachiofacial features in three, and brachial in one. CT showed lenticular nucleus and internal capsule lesions in all of them, head of caudate nucleus in three, and white substance in two. MRI was done in two and confirmed CT findings. Electroencephalogram, at the acute phase in three, showed abnormalities in all patients.

Key words: striatocapsular infarction, cerebral ischemia, acute hemiplegia, childhood.

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Aceite: 7-março-1994.

Dr. Alfredo Leboreiro Fernandez - Rua Belém 45 - 38061-390 Uberaba MG - Brasil.

Referências bibliográficas

1. Alexander L. The vascular supply of the striopallidum. In Alexander L (ed). The diseases of the basal ganglia. Baltimore.Williams & Wilkins, 1942.
2. Blandin PF, Berkovic SF. Striatocapsular infarction: large infarcts in the lenticulostriate arterial territory. Neurology 1984, 34: 1423-1430.
3. Bogousslavsky J, Regli F. Capsular genu syndrome. Neurology 1990, 40: 1499-1502.
4. Castaldo JE, Anderson M, Reevers AG. Middle cerebral artery occlusion with migraine. Stroke 1982, 13: 308-311.
5. Cerebral Embolism Task Force (Dyken ML, Fisher M, Harrison MJG, Hart RG, Sherman DG). Cardiogenic brain embolism. Arch Neurol 1986, 43: 71-84.
6. Donnan GA, Blandin PF, Berkovic SF, Longley WA, Saling MM. The stroke syndrome of striatocapsular infarction. Brain 1991, 114: 51-70.
7. Faught E. Current role of electroencephalography in cerebral ischemia. Stroke 1993, 24: 609-613.
8. Fischer CM. Lacunar strokes and infarcts: a review. Neurology 1982, 32: 871-876.
9. Friberg L, Olsen TS, Roland PE, Lassen NA. Focal ischemia caused by instability of cerebrovascular tone during attacks of hemiplegic migraine. Brain 1987, 110: 917-934.
10. Gibo H, Carver CC, Rhoton AL Jr, Lenkey C, Mitchell R J. Microsurgical anatomy of the middle cerebral artery. J Neurosurg 1981, 54: 151-169.
11. Gillilan LA. The arterial and venous blood supplies to the forebrain (including the internal capsule) of primates. Neurology 1968, 18: 653-670.
12. Gilman S. Advances in Neurology: cerebrovascular disease. N Engl J Med 1992, 326: 1672-1676.
13. Healton EB, Navarro C, Bressman S, Brust JCM. Subcortical neglect. Neurology 1982, 32: 776-778.
14. Jackson AC, Boughner DR, Barnett HJM. Mitral valve prolapse and cerebral ischemic events in young patients. Neurology 1984, 34: 784-787.
15. Jasper H. Report of committee on methods of clinical exam in EEG. EEG Clin Neurophysiol 1958, 10: 370-375.
16. Kapelle LJ, Willemse J, Ramos LMP, van Gijn J. Ischaemic stroke in the basal ganglia and internal capsule in childhood. Brain Develop 1989, 11: 283-292.
17. MacDonell RAL, Donnan GA, Bladin PF, Berkovic SF, Wriedt CHR. The electroencephalogram and acute ischemic stroke: distinguishing cortical from lacunar nfarction. Arch Neurol 1988, 45: 520-524.
18. Maki Y, Akimoto H, Enomoto T. Injuries of basal ganglia following trauma in children. Child's Brain 1980, 7: 113-123.
19. Moura-Ribeiro MVL, Rocha CM, Fernandes WLM, Guerreiro MM. Meningites bacterianas agudas: complicações vasculares. Arq Neuropsiquiatr 1993, 51: 507-510.
20. Niedermeyer E. Cerebrovascular Disorders and EEG. In Niedermeyer E, Lopes da Silva F. (eds). Eletroencephalography. Baltimore: Urban & Schwarzenberg, 1982, p 233.
21. Pierangeli G. 9th International Migraine Symposium. London, 1992. World Neurol 1993, 8: 9.
22. Rossi LN. Headache in childhood. Child's Nerv Syst 1989, 5: 129-134.
23. Rossi LN, Penzien JM, Deonna T, Gutieres F, Vassella F. Does migraine-related stroke occur in childhood? Dev Med Child Neurol 1990, 32: 1005-1021.
24. Satoh S, Shirane R, Yoshimoto T. Clinical survey of ischemic cerebrovascular disease in children in a district of Japan. Stroke 1991, 22: 586-589.
25. Schoenberg BS, Meilinger JF, Schoenberg DG. Cerebrovascular disease in infants and children: a study of incidence, clinical features and survival. Neurology 1978, 28: 763-768.
26. Sohn YH, Lee BI, Sunwoo IN, Kim KW, Suh JH. Effect of capsular infart size on clinical presentation of stroke. Stroke 1990, 21: 1258-1261.
27. van der Zwan A, Hillen B. Review of the variability of the territories of the major cerebral arteries. Stroke 1991, 22: 1078-1084.
28. Wiznitzer M, Masaryk TJ. Cerebrovascular abnormalities in pediatric stroke: assessment using parenchymal and angiographic magnetic resonance imaging. Ann Neurol 1991, 29: 585-589.
29. Wolf PA, Sila CA. Cerebral ischemia with mitral valve prolapse. Am Heart J 1987, 113: 1308-1315.

Datas de Publicação

Publicação nesta coleção
19 Jan 2011
Data do Fascículo
Set 1994

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Alexander L. The vascular supply of the striopallidum. In Alexander L (ed). The diseases of the basal ganglia. Baltimore.Williams & Wilkins, 1942.

[2] 2. Blandin PF, Berkovic SF. Striatocapsular infarction: large infarcts in the lenticulostriate arterial territory. Neurology 1984, 34: 1423-1430.

[3] 3. Bogousslavsky J, Regli F. Capsular genu syndrome. Neurology 1990, 40: 1499-1502.

[4] 4. Castaldo JE, Anderson M, Reevers AG. Middle cerebral artery occlusion with migraine. Stroke 1982, 13: 308-311.

[5] 5. Cerebral Embolism Task Force (Dyken ML, Fisher M, Harrison MJG, Hart RG, Sherman DG). Cardiogenic brain embolism. Arch Neurol 1986, 43: 71-84.

[6] 6. Donnan GA, Blandin PF, Berkovic SF, Longley WA, Saling MM. The stroke syndrome of striatocapsular infarction. Brain 1991, 114: 51-70.

[7] 7. Faught E. Current role of electroencephalography in cerebral ischemia. Stroke 1993, 24: 609-613.

[8] 8. Fischer CM. Lacunar strokes and infarcts: a review. Neurology 1982, 32: 871-876.

[9] 9. Friberg L, Olsen TS, Roland PE, Lassen NA. Focal ischemia caused by instability of cerebrovascular tone during attacks of hemiplegic migraine. Brain 1987, 110: 917-934.

[10] 10. Gibo H, Carver CC, Rhoton AL Jr, Lenkey C, Mitchell R J. Microsurgical anatomy of the middle cerebral artery. J Neurosurg 1981, 54: 151-169.

[11] 11. Gillilan LA. The arterial and venous blood supplies to the forebrain (including the internal capsule) of primates. Neurology 1968, 18: 653-670.

[12] 12. Gilman S. Advances in Neurology: cerebrovascular disease. N Engl J Med 1992, 326: 1672-1676.

[13] 13. Healton EB, Navarro C, Bressman S, Brust JCM. Subcortical neglect. Neurology 1982, 32: 776-778.

[14] 14. Jackson AC, Boughner DR, Barnett HJM. Mitral valve prolapse and cerebral ischemic events in young patients. Neurology 1984, 34: 784-787.

[15] 15. Jasper H. Report of committee on methods of clinical exam in EEG. EEG Clin Neurophysiol 1958, 10: 370-375.

[16] 16. Kapelle LJ, Willemse J, Ramos LMP, van Gijn J. Ischaemic stroke in the basal ganglia and internal capsule in childhood. Brain Develop 1989, 11: 283-292.

[17] 17. MacDonell RAL, Donnan GA, Bladin PF, Berkovic SF, Wriedt CHR. The electroencephalogram and acute ischemic stroke: distinguishing cortical from lacunar nfarction. Arch Neurol 1988, 45: 520-524.

[18] 18. Maki Y, Akimoto H, Enomoto T. Injuries of basal ganglia following trauma in children. Child's Brain 1980, 7: 113-123.

[19] 19. Moura-Ribeiro MVL, Rocha CM, Fernandes WLM, Guerreiro MM. Meningites bacterianas agudas: complicações vasculares. Arq Neuropsiquiatr 1993, 51: 507-510.

[20] 20. Niedermeyer E. Cerebrovascular Disorders and EEG. In Niedermeyer E, Lopes da Silva F. (eds). Eletroencephalography. Baltimore: Urban & Schwarzenberg, 1982, p 233.

[21] 21. Pierangeli G. 9th International Migraine Symposium. London, 1992. World Neurol 1993, 8: 9.

[22] 22. Rossi LN. Headache in childhood. Child's Nerv Syst 1989, 5: 129-134.

[23] 23. Rossi LN, Penzien JM, Deonna T, Gutieres F, Vassella F. Does migraine-related stroke occur in childhood? Dev Med Child Neurol 1990, 32: 1005-1021.

[24] 24. Satoh S, Shirane R, Yoshimoto T. Clinical survey of ischemic cerebrovascular disease in children in a district of Japan. Stroke 1991, 22: 586-589.

[25] 25. Schoenberg BS, Meilinger JF, Schoenberg DG. Cerebrovascular disease in infants and children: a study of incidence, clinical features and survival. Neurology 1978, 28: 763-768.

[26] 26. Sohn YH, Lee BI, Sunwoo IN, Kim KW, Suh JH. Effect of capsular infart size on clinical presentation of stroke. Stroke 1990, 21: 1258-1261.

[27] 27. van der Zwan A, Hillen B. Review of the variability of the territories of the major cerebral arteries. Stroke 1991, 22: 1078-1084.

[28] 28. Wiznitzer M, Masaryk TJ. Cerebrovascular abnormalities in pediatric stroke: assessment using parenchymal and angiographic magnetic resonance imaging. Ann Neurol 1991, 29: 585-589.

[29] 29. Wolf PA, Sila CA. Cerebral ischemia with mitral valve prolapse. Am Heart J 1987, 113: 1308-1315.