边缘系统脑梗死12例急性期认知障碍特点分析  

Analysis of cognitive impairment of 12 patients with limbic system cerebral infarction in the acute stage

作　　者：王珊[1] 梁娜 温雅[1] 李畅 智桂琴 封玉瑶 生晓娜[1] Wang Shan;Liang Na;Wen Ya;Li Chang;Zhi Guiqin;Feng Yuyao;Sheng Xiaona(Department of Neurology,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第二医院神经内科,石家庄050000

出　　处：《脑与神经疾病杂志》2021年第2期80-84,共5页Journal of Brain and Nervous Diseases

基　　金：河北省自然科学基金资助项目(H2017206156)。

摘　　要：目的观分析12例边缘系统脑梗死患者急性期认知障碍特点,为临床早期诊断及监测预后提供依据。方法收集2018年1月至2019年6月收治的12例边缘系统脑梗死患者的病例资料,采用简易精神状态量表(MMSE)和蒙特利尔认知评估量表(MoCA)评价认知障碍程度与特点。结果12例患者部位分别累及海马(5例)、穹窿柱(1例)、丘脑前核(4例)和扣带回(2例),其中伴海马梗死者TOAST病因分型为大动脉粥样硬化型。12例患者MMSE(18±6)、MoCA(13±5)、画钟(1.75±1.14)评分均显著下降,以记忆力下降为突出表现同时伴执行、注意计算、定向、视空间等多个认知域不同程度受损,命名相对保留。对各梗死部位认知损害分析发现,以海马梗死为主记忆、视空间损伤严重;扣带回则记忆、执行、注意受损严重;丘脑前核、穹窿柱梗死面积小但导致显著认知障碍。所有患者NIHSS评分为1.83±0.56分,神经功能损伤轻。结论边缘系统脑梗死可导致以近记忆力下降为突出表现伴多个认知域受损的严重认知障碍及轻微局灶神经症状,DWI和认知评估有助于早期发现、药物和康复治疗综合干预改善卒中后认知障碍。Objective To analyze the characteristics of cognitive impairment in 12 patients with limbic system cerebral infarction in the acute stage,further provide the grounds of clinical early diagnosis and assessment of prognosis.Methods The case data of 12 patients with limbic system cerebral infarction hospitalized from January 2018 to June 2019 were collected,Mini-Mental State Examination and Montreal Cognitive Assessment were performed to assess the severity and features of cognitive impairments.Results The infarction sites of 12 patients involved the hippocampus(5 cases),fornical column(1 case),anterior thalamic nucleus(4 cases)and cingulate gyrus(2 cases),respectively,among which the patients with hippocampal infarction were classified as large-artery atherosclerosis in TOAST type.Twelve patients showed that MMSE,MoCA and picturing clock scores were significantly decreased and memory impairment was prominently characteristic accompanying the impairments of multiple cognitive domains such as execution,attention,computation,directional ability,visuospatial skills and so on,naming abilities were relatively retained.Through analyzing cognitive lesions of infarct locations,the hippocampal infarct presented obvious memory and visuospatial skills impairments,whereas the infarct referring to cingulate gyrus showed memory,execution and attention decreased significantly.Small infarction in anterior thalamic nucleus and fornical resulted in significant cognitive impairments All cases presented the mild neurologic dysfunction with NIHSS scores 1.83±0.56.Conclusion Limbic system cerebral infarctions can lead to serious cognitive impairments involved in obvious memory damage and other multiple cognitive domains and mild focal neurologic symptoms,DWI and cognitive evaluation contribute to early diagnosis,comprehensive intervention including drug and rehabilitative treatments should be performed to improve post stroke cognitive impairment.

关 键 词：边缘系统 脑梗死 认知障碍 

分 类 号：R743.32[医药卫生—神经病学与精神病学]