以发作性体位性视物双影为前期症状的后循环卒中1例  

Posterior inferior cerebellar artery infarction with episodic postural diplopia as the initial symptom:A case report

作　　者：范常锋[1,2] 黄亚平 李霞[1] 陈芸 李真[3] 乔淑冬[1] FAN Chang-feng;HUANG Ya-ping;LI Xia;CHEN Yun;LI Zhen;QIAO Shu-dong(Department of Neurology,Peking University Shougang Hospital,Beijing 100041,China;Department of Geriatrics,Peking University Shougang Hospital,Beijing 100041,China;Department of ophthalmology,Peking University Shougang Hospital,Beijing 100041,China)

机构地区：[1]北京大学首钢医院神经内科,北京100041 [2]北京大学首钢医院老年医学科,北京100041 [3]北京大学首钢医院眼科,北京100041

出　　处：《北京大学学报（医学版）》2023年第4期762-765,共4页Journal of Peking University:Health Sciences

摘　　要：后循环缺血性卒中急性期头颅CT检出率低,甚至MRI检查也具有较高的假阴性率,而后循环缺血性卒中极易进行性加重甚至危及生命,所以规范的临床查体以及对后循环病变特征性症状、体征的识别具有极其重要的意义。但是以发作性体位性视物双影为前期症状的后循环卒中病例罕见报道,本文报道1例以发作性体位性视物双影为首发症状的小脑后下动脉供血区梗死病例,以期为临床上后循环缺血性卒中诊断和治疗提供依据。Accurate and timely diagnosis of posterior circulation ischemic stroke is a challenge for emergency neurology clinicians,even MRI scan which is believed to be sensitive to acute ischemic lesions may be negative.It is particularly important to obtain the typical or characteristic symptoms and signs of the patients through comprehensive physical examination.We report a case of posterior inferior cerebellar artery(PICA)territory infarction with“episodic postural diplopia”as the initial symptom,hoping that clinicians notice the vertical diplopia caused by the disfunction of otolith gravity conduction pathway,which is characterized by the degree of diplopia being affected by postural changes.A 44-year-old man was in hospital due to episodic postural diplopia for 4 months,dizziness and unstable walking for 5 days.In the past four months,the patient had endured episodic diplopia attack for 8 times when standing or walking,which could be relieved obviously while lying down and gradually disappeared within 5-10 minutes.He had not seen a doctor since the outbreak of the novel coronavirus.Five days before admission,diplopia worsened accompanying obvious vertigo,nausea and vomiting,left facial numbness,and hiccups.The diplopia could be relieved after taking the supine position,but not completely disappear as before.Physical examination showed a triad of ocular tilt response(OTR),namely static ocular rotation(SOT),skew deviation(SD)and head tilt(HT).And also subjective visual vertical(SVV)deviation was found.Those signs were considered for otolith gravity conduction system involvement.Combined with other clinical signs,such as Horner signs,crossed sensory disorders,ataxia,and MRI scan,it was easy to find the infarction was in the territory of the left PICA.The reasons for the patient’s“episodic posi-tional diplopia”in the early stage of the disease were considered as follows:(1)the gravity was less affected in the supine position,the stimulation of the otolith gravity conduction pathway was reduced,so the degree of

关 键 词：复视 脑梗死 耳石重力传导通路 直立仰卧试验 

分 类 号：R743.3[医药卫生—神经病学与精神病学]