急性手结区梗死的临床及影像学特点分析  

Clinical and imaging features of acute infarction of hand knob area

作　　者：孙晓欣 张志勇 刘新秀 朱瑞[1] 付彦[1] 张艳丽[1] Sun Xiaoxin;Zhang Zhiyong;Liu Xinxiu;Zhu Rui;Fu Yan;Zhang Yanli(Department of Neurology,Beijing Geriatric Hospital,Beijing 100095,China)

机构地区：[1]北京老年医院神经内科,100095

出　　处：《北京医学》2023年第4期307-311,共5页Beijing Medical Journal

摘　　要：目的 探讨急性手结区梗死患者的临床及影像学特点。方法 选取2017年10月至2021年10月在北京老年医院神经内科住院的急性手结区梗死患者,根据影像特点分为孤立病变组和多发病变组,分析患者临床及影像学特点,并观察患者出院后半年规律随访的结果。结果 共纳入20例急性手结区梗死患者,其中男17例,女3例,年龄3~83岁,平均(59.2±18.0)岁;孤立病变组9例,多发病变组11例。全部患者均表现为单手瘫,其中孤立性手瘫12例(60.0%)、伴同侧手麻5例(25.0%)、伴构音障碍3例(15.0%)。最常见的卒中病因是大动脉粥样硬化型(large-artery atherosclerosis,LAA)(8例,40.0%),其次为小血管闭塞型(small-artery occlusion,SAO)(6例,30.0%),少见病因包括烟雾病、颈动脉夹层及颈动脉体瘤。孤立病变组SAO型病因占比高于多发病变组(66.7%比0.0%),LAA型病因占比低于多发病变组(11.1%比63.6%),差异均有统计学意义(P <0.05)。急性手结区梗死在头颅MRI的新发病灶直径为0.5~12 mm,病灶仅局限于手结区或散发于皮层;病灶30.0%在手结区内侧、以尺侧3指无力为主,15.0%在外侧、为桡侧2指无力,55.0%累及整个手结区,为全手无力。6个月随访期内95.0%患者预后良好,无死亡,仅1例LAA型患者出现复发脑梗死。结论 急性手结区梗死是罕见的卒中类型,此类卒中总体预后良好。主要临床表现为孤立性手瘫,最常见的卒中病因为LAA及SAO,头颅MRI显示病灶分布对病因及临床表现有一定的提示作用。Objective To explore the clinical and imaging features of acute infarction of hand knob area.Methods The patients with acute infarction of hand knob area diagnosed in the Department of Neurology,Beijing Geriatric Hospital from October 2017 to October 2021 were selected,and were divided into solitary lesion group and multiple lesion group according to the imaging characteristics.The clinical and imaging features of the patients were analyzed,and the regularly half-a-year follow up results of the patients were observed after discharge.Results A total of 20 patients with acute infarction of hand knob were included,including 17 males and three females,aged from 3 to 83 years,with an average age of(59.2 ±18.0) years.There were nine cases in isolated lesion group and 11 cases in multiple lesion group.All patients showed unilateral paralysis,including 12 cases(60.0%) of isolated hand paralysis,five cases(25.0%) of ipsilateral hand anesthesia and three cases(15.0%) of dysarthria.The most common cause of stroke was large-artery atherosclerosis(LAA)(eight cases,40.0%),followed by small-artery occlusion(SAO)(six cases,30.0%).Rare causes of stroke included moyamoya disease,carotid dissection and carotid body tumor.The proportion of SAO-type etiology in isolated lesion group was higher than that in multiple lesion group(66.7% vs.0.0%),while the proportion of LAA-type etiology was lower than that in multiple lesion group(11.1% vs.63.6%),and the differences were statistically significant(P<0.05).The diameter of the newly developed lesion of acute infarction of hand knot area was 0.5 ~ 12 mm on MRI,and was confined to hand knot area or scattered in cortex.30.0% of the lesions were located in the inner hand knot area,mainly in the ulnar side with three fingers weakness,15.0% in the outer radial side with two fingers weakness,and 55.0% involved the whole hand knot area with total hand weakness.During the 6-month follow-up period,95.0% of the patients had a good prognosis without death,and only one patient with LAA type had recurr

关 键 词：手结区 手运动皮层 孤立性手瘫 卒中 病因 影像学特点 

分 类 号：R743.3[医药卫生—神经病学与精神病学]