脑血管病的近体空间忽视  

Peripersonal space neglect in patients with cerebral vascular disease

作　　者：魏敬能[1] 汪凯[1] 

机构地区：[1]安徽医科大学第一附属医院神经内科,合肥230022

出　　处：《中华神经医学杂志》2005年第12期1241-1244,共4页Chinese Journal of Neuromedicine

摘　　要：目的了解脑血管病所致脑损伤后近体空间忽视的发生率、忽视组脑损伤部位的分布及偏盲的发生情况,探讨忽视的临床表现特点及其机制。方法应用划消试验、临摹画图、自发画图、行为测查以及视野计对73例临床确诊的单侧脑损伤患者进行忽视筛查、视野检查,并对其损伤部位进行分析。结果在发病后3周评估,忽视的发生率为28.8%,其中右大脑半球忽视的发生率为40.0%,左大脑半球忽视的发生率为15.2%(P<0.01);发病后6周评估,忽视的发生率为19.2%,其中右大脑半球忽视的发生率为32.5%,左大脑半球忽视的发生率为3.03%(P<0.01)。忽视组:涉及顶叶占61.9.5%,颞叶占52.4%,额叶占23.8%,枕叶占23.8%,基底节占19.0%,丘脑占14.3%,岛叶占9.52%,扣带回占4.76%。忽视组偏盲的发生率为52.3%,非忽视偏盲的发生率为11.5%(P<0.01)。右大脑半球忽视程度较左大脑半球严重、持久,且非表现绝对偏侧忽视。结论空间忽视发生率主要受评估的方法和评估的时间影响,右大脑半球忽视的发生率高于左大脑半球;忽视组脑损伤部位主要见于顶叶、颞叶,忽视组偏盲的发生率高于非忽视组。忽视的机制可能为空间一侧成分缺陷和非一侧成分缺陷交互作用而产生。Objective To investigate the incidence of peripersonal space neglect and hemianopia after brain damage, and to explore clinical characteristics and mechanism of neglect syndrome as well as distributions of brain damage locations of periperonal neglect patients. Methods Seventy-three patients with single brain damage were diagnosed whether they had neglect syndrome by cancellation test, copying daisy test, drawing clock test, behavior test, and whether they had visual deficit by perimeter. Their brain damage locations were also analyzed. Results The incidence of hemineglect was 28.8% 3 weeks after damage, of which 40.0% were right brain damage （RBD） patients and 15.2% were left brain damage （LBD） patients （P〈0.01）. The incidence of hemineglect was 19.2% at 6th week, of which 32.5% were right brain damage patients and 3.03% were left brain damage patients （P〈0.01）. The location involved in the parietal was in 61.95%, temporal lobe in 52.4%, frontal lobe in 23.8%, occipital lobes in 23.8%, basal ganglia in 19.0%, thalamus in 14.3%, insulae lobes in 9.52%, gyrus cinguli in 4.76%. The incidence ofhemianopia was in 52.3% of peripersonal neglect group and in 11.5% of non-neglect group （P〈0.01）. The syndrome of fight neglect was more severe and lasted longer than left neglect, and these syndromes were not always absolute lateralized. Conclusion The incidence of peripersonal space neglect is affected by the nature and timing of assessment. The incidence of neglect with fight hemisphere damage is higher than with left hemisphere damage. The damage location in the peripersonal neglect group appears to be common in parietal and temporal lobes. The incidence of hemianopia in the peripersonal neglect group was higher than that in the non-neglect group. It is reasonable to interpret the mechanism of neglect as interactions between spatially lateralized and non-lateralized component deficit.

关 键 词：近体空间忽视 损伤部位 偏盲 

分 类 号：R743[医药卫生—神经病学与精神病学]