肢体抖动性短暂性脑缺血发作临床分析  

Clinical analysis of limb-shaking transient ischemic attacks

作　　者：杨玉峰[1] 张殿印[1] 

机构地区：[1]河南安阳地区医院神经内二科,安阳455000

出　　处：《中国实用神经疾病杂志》2008年第12期43-44,共2页Chinese Journal of Practical Nervous Diseases

摘　　要：目的探讨肢体抖动性短暂性脑缺血发作的临床表现及诊断,提高临床医师对这一症候的认识。方法采用动态脑电图、经颅多普勒超声、颈部血管超声、头部核磁共振、核磁共振血管成像、全脑血管造影等辅助检查,对4例肢体抖动性短暂性脑缺血发作患者进行临床表现、辅助检查及影像学资料分析。结果4例患者均表现为肢体发作性短暂不能控制的抖动,其发作均有明显诱因,其中2例曾被误诊为癫,给予抗癫治疗无效。全部患者均有抖动肢体对侧至少1条以上颅内和(或)颅外动脉严重狭窄或闭塞,头部核磁共振3例显示抖动肢体对侧分水岭脑梗死,发作期脑电图检查未见癫波释放,给予抗血小板聚集、扩容或者血管内支架治疗后,症状均消失。结论肢体抖动性短暂性脑缺血发作常表现为发作性、无意识的肢体抖动,和局灶性运动性癫发作相似,易误诊为局灶性癫,通常提示大血管严重的狭窄或闭塞,低灌注是其最可能的发病机制,通过脑电图及全脑血管造影等检查可以明确诊断,防止漏诊及误诊。Objective To approach limb-shaking transient ischemic attacks clinical features and diagnosis by history and examination of 4 typical patients with review literature, aiming to warn physicians about this sign. Methods Video-electroencephalography（EEG）, transeranial Doppler, cervical vascular ultrasound, brain magnetic resonance imaging（MRI）, magnetic resonance angiography（MRA） and digital subtract angiography（DSA） were peincluded formed in 4 patients. The clinical features, examination and neuroimage data were analyzed. Results The clinical features included a paroxysmal, brief, involuntary limb-shaking. All patients had obvious precipitating, 2 patients were misdiagnosed as epilepsy. And antiepileptic had no effect. The contralateral internal cervical artery or middle cerebral artery showed critical stenosis or occlusion. In all 4 patients, the brain MRI showed typical watershed cerebral infarction in 3 patients,video-EEG studies failed to show epileptiform activity. The antiplatelet drugs, volum dilution therapy or percutaneous angioplasty were administered in 4 patients. All of them became asymptomatic. Conclusion The clinical feature of limb-shaking transient ischemic attacks is paroxysmal unconscious limb shaking. It is sometimes mistaken for focal motor seizure, because of its similar appearance. The patients with limb-shaking transient ischemic attacks almost invariably have severe carotid senosis or occlusion. Hypoperfusion may be the mechanism of pathogenesis. It could be recognized by EEG and DSA examination.

关 键 词：肢体抖动 短暂性脑缺血发作 动脉狭窄 

分 类 号：R743.31[医药卫生—神经病学与精神病学]