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Het arterieel cerebraal infarct bij de pasgeborene

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Tijdschrift voor Kindergeneeskunde

Samenvatting

Het arterieel cerebraal infarct bij dà terme neonaat is de tweede meest voorkomende oorzaak van neonatale convulsies met een incidentie geschat op 1:4500 en komt waarschijnlijk vaker voor dan gedacht. De eerste symptomen bestaan meestal uit focale motorische convulsies van het contralaterale ledemaat. De risicofactoren op een infarct zijn meestal gerelateerd aan het acute ziektebeeld van het kind, hoewel een duidelijke oorzaak vaak niet gevonden wordt. Pre-Wallerse en Wallerse degeneratie op MRI zijn prognostisch voor latere hemiplegie. Hemiplegie ontstaat in ongeveer 30% van de gevallen. Wij presenteren twee patiënten met neonatale convulsies als gevolg van een arterieel cerebraal infarct. In de eerste patiënt werd geen oorzaak gevonden. In de tweede patiënt vonden wij alleen een heterozygote MTHFR (methyleentetrahydrofolaatreductase) C677T-mutatie die misschien een rol zou kunnen spelen bij het ontstaan. Dit artikel geeft een overzicht van de epidemiologie, etiologie, klinische symptomen, evaluatie en prognose.

Summary

Arterial cerebral infarction in full term infants is the second most common cause of neonatal seizures with an incidence estimated to be 1:4500 and is probably more common than currently appreciated. The usual presenting symptoms are focal motor seizures of the contralateral limbs. The risk factors for the development of an infarction is usually related to the acute illness of the patient, although, often a specific cause cannot be identified. Pre-Wallerian and Wallerian degeneration on MRI is a prognostic sign for development of hemiplegia. Hemiplegia develops in approximately 30% of the cases.We present two patients with neonatal seizures as a result of an arterial cerebral infarction. In the first patient a specific cause could not be identified. In the second patient we only found a heterozygote MTHFR (methylenetretrahydrofolate reductase) C677T mutation which could play a role in the aetiology. This paper gives an overview of the epidemiology, aetiology, clinical symptoms, evaluation, and prognosis.

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    J. E. H. Bunt

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  1. J. E. H. Bunt
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  2. M. E. van der Putten
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  3. A. B. C. Roeleveld-Versteegh
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  4. S. Zuethoff
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Correspondence to J. E. H. Bunt.

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Mw. drs. M.E. van der Putten, anios Kindergeneeskunde (thans: aios Kindergeneeskunde, Academisch Ziekenhuis Maastricht), mw. drs. A.B.C. Roeleveld-Versteegh, kinderarts, dr. J.E.H. Bunt, kinderarts-neonatoloog, mw. drs. S. Zuethoff, anios Kindergeneeskunde (thans: anios Kindergeneeskunde, Wilhelmina Kinderziekenhuis, UMCU), afdeling Kindergeneeskunde, Catharina Ziekenhuis, Eindhoven.

Correspondentieadres: Dr. J.E.H. Bunt, afdeling Kindergeneeskunde, Catharina Ziekenhuis, Postbus 1350, 5602 ZA Eindhoven,

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Bunt, J.E.H., van der Putten, M.E., Roeleveld-Versteegh, A.B.C. et al. Het arterieel cerebraal infarct bij de pasgeborene. KIND 76, 27–33 (2008). https://doi.org/10.1007/BF03078172

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