Holmes震颤临床特征与诊治分析  

Clinical characteristics of Holmes tremor and its diagnosis and treatment

作　　者：吕心煌 洪倩 童秋玲[1] 李静[1] 张扬[1] 陈为安[1] LYU Xinhuang;HONG Qian;TONG Qiuling;LI Jing;ZHANG Yang;CHEN Weian(Department of Neurology,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325015,China)

机构地区：[1]温州医科大学附属第一医院神经内科,浙江温州325015

出　　处：《温州医科大学学报》2020年第8期632-636,共5页Journal of Wenzhou Medical University

基　　金：浙江省自然科学基金资助项目(LY15H090019)。

摘　　要：目的:探讨Holmes震颤(HT)临床特征、病因、影像学表现及治疗。方法:对2015年9月至2018年6月温州医科大学附属第一医院收治的6例HT患者的病历资料和录像资料进行回顾性分析。结果:男4例、女2例,年龄14~67岁。病因:脑出血3例、脑梗死1例、外伤性脑损伤1例、视神经脊髓炎谱系病1例。原发病至震颤发生的中位潜伏期为2个月(14 d^8个月)。HT合并的症状/体征:偏瘫4例、共济失调3例、感觉减退3例、肌张力障碍2例、颅神经受累、构音障碍及软腭阵挛各1例。头颅MRI显示病变累及中脑5例、丘脑4例,桥脑1例。短期内左旋多巴治疗明显缓解1例、中度缓解2例,3例联合氯硝西泮治疗明显缓解2例,无效1例。3例在3年间随访均存在疗效减退。结论:本组HT最常见的病因是血管病变,最常见的受累部位为中脑和(或)丘脑。短期内左旋多巴和氯硝西泮有一定治疗效果,长期使用疗效减退。Objective:To explore the clinical characteristics,etiology,imaging manifestations and treatment of Holmes tremor(HT).Methods:A retrospective analysis of the medical records and videos of 6 HT patients in the First Affiliated Hospital of Wenzhou Medical University from September 2015 to June 2018 was made.Results:A total of 2 females and 4 males were included,aged ranging 14-67 years at the moment of CNS insult.Etiology showed hemorrhage in 3 cases,infarction in 1 case,traumatic brain injury in 1 case,and optic neuromyelitis spectrum disease in 1 case.The median latency from lesion to tremor onset was 2 months(ranging from 14 days to 8 months).Symptoms/signs associated with HT included hemiplegia in 4 cases,ataxia in 3 cases,hypoesthesia in 3 cases,dystonia in 2 cases,cranial nerve involvement,dysarsaras and palatal clonus in 1 case.MRI showed lesions in midbrain 5 cases,thalamus 4 cases,and pontine in 1 case.In the short term,levodopa treatment significantly relieved 1 case and moderately relieved 2 cases:in 3 cases with combined treatment of clonazepam,2 cases were significantly alleviated,but ineffective in 1 case.Three-year follow-up of 3 cases showed decline in effect.Conclusion:The most common causes of HT in our series were vascular lesions.The most common lesion topography was mesencephalic,thalamic,or both.Levodopa and clonazepam have a certain therapeutic effect in the short term,but the long-term therapeutic effect is decreased.

关 键 词：Holmes震颤 中脑 临床特征 左旋多巴 

分 类 号：R741[医药卫生—神经病学与精神病学]