Neurology CP:为什么脑梗死后特发性震颤消失了?

2020-02-22 杨中华 脑血管病及重症文献导读

特发性震颤(Essential tremor,ET)是一种最常见的成人发作性运动障碍性疾病。特征为姿势和动作性震颤,常累及上肢,有时候也累及下肢、头部、声音和躯干。而且,ET 常伴阳性家族史。丘脑切开术和丘脑深部脑刺激已经被成功用于治疗 ET。

特发性震颤(Essential tremor,ET)是一种最常见的成人发作性运动障碍性疾病。特征为姿势和动作性震颤,常累及上肢,有时候也累及下肢、头部、声音和躯干。而且,ET 常伴阳性家族史。丘脑切开术和丘脑深部脑刺激已经被成功用于治疗 ET。

2019年12月来自中南医院的Chunhua Xi等在 Neurology Clinical Practice 上报道了1例症状超过60年的双侧 ET 患者,左侧放射冠梗死后右侧 ET 消失。

83岁,右利手男性。缓慢进展,双侧,低频,动作和姿势性震颤,头部或声音未受累。其父亲和儿子有类似的症状。ET 并未影响到患者的日常生活,因此一直未服用药物。

2016年10月因突发构音障碍、口角歪斜和右侧上下肢无力就诊,当时查体发现右侧长期存在的 ET 消失,NIHSS 3分。

头 MRI 显示左侧放射冠梗死(下图 A-C):



15个月后随访,右侧上下肢偏瘫完全恢复,右侧震颤也没有出现,但是左侧上肢震颤以及左腿姿势性震颤未改变。复查 MRI(下图 D 和 E)左侧皮层下放射冠仅见小片低信号 T1 信号,被 T2 flair 高信号区域环绕(下图 F):



为了研究脑梗死对运动神经纤维束的作用,3D 张量纤维束成像显示与对侧相比,其皮质脊髓纤维明显减少(图 G-I):



该患者的右侧震颤一直未再出现。

作者认为该3D-张量纤维束影像学提示内囊后部的皮层脊髓纤维通路可能是右侧 ET 消失的原因。

原始出处:Chunhua Xi, Sirui Li, Yumin Liu, Bin Mei. Disappearance of long-term right-sided essential tremor after stroke in the left corona radiata. Neurology Clinical Practice. December 2019

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    2020-11-22 yinhl1978
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    2020-02-24 karmond
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    2020-02-24 kalseyzl

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