一侧大脑半球局灶性病变时脑高级感觉的优势化倾向

Cerebral dominance of higher somatic sensations in focal unilateral cerebral hemisphere lesion

目的:探讨一侧大脑半球局灶性病变患者是否存在脑高级感觉的优势化倾向?方法:2003-02/2004-07大连市中心医院收治140例一侧大脑半球局灶性病变的患者,根据病变部位将患者分为3组:顶叶组(n=54,病变位于顶叶及与之交界处),非顶脑叶组(n=43,病灶在额叶、颞叶、枕叶),基底核组(n=43,病变部位在基底核区)。对所有患者进行初级感觉(痛觉、温度觉、触觉、振动觉)和高级感觉(辨质觉、实体觉、重量觉、书画觉及皮肤运动方向觉)的检查。结果:左半球病变时,初级感觉检查的阳性率为56%(43/77),右半球病变时为62%(39/63),两者比较差异无显著性意义(χ2=0.4730,P>0.25)。非顶脑叶病变组无高级感觉障碍患者,故不参加比较。顶叶组左、右侧高级感觉检查的阳性率分别为27%(9/33),33%(7/21);基底核组左、右侧高级感觉检查的阳性率分别为26%(5/19),33%(8/24),均为右侧高于左侧,但差异均无显著性意义(χ2=0.5245,0.2476;P均>0.05)。进一步比较左、右侧各种高级感觉障碍的阳性率,其结果均无统计学差异。结论:高级感觉(辨质觉、实体觉、重量觉、书画觉及皮肤运动方向觉)无明显脑优势化现象。

AIM:To investigate whether cerebral dominance of higher somatic sensations exists in patients with focal unilateral cerebral hemisphere lesion or not. METHODS:Totally 140 patients with focal unilateral cerebral hemisphere lesion selected from the Department of Neurology,Dalian Central Hospital,from February 2003 to July 2004,were divided into the three groups: parietal lobe group(n=54,lesion in parietal lobe and relays),non parietal lobe group(n=43,lesion located in frontal lobe,temporal lobe and occipital lobe) and basal ganglia group(n=43,lesion located in basal ganglia);primary sensations(pain sensation, thermal sensation,taction and vibration sensation) and senior sensations(substance sensation, stereognosis,weight sensation,painting and calligraphy,and skin moving direction sensation) were examined in all patients. RESULTS:The positive rate of primary sensations was 56%(43/77) in patients with lesion in left hemisphere,and 62%(39/63) in right hemisphere, and there was significant difference(χ2=0.473 0, P >0.25).No patients with senior sensory disturbance appeared in non parietal lobe group, so they were not selected as controls. The positive rate of senior sensations in left and right unilateral cerebral hemisphere in parietal lobe group was 27%(9/33) and 33%(7/21), respectively,and 26%(5/19) and 33%(8/24) in basal ganglia group.The positive rates of senior sensations in left hemisphere were all higher than those in right hemisphere,but there was no significant difference(χ2=0.524 5, 0.247 6; P >0.05).The differences were not significant(P >0.10,P >0.25). CONCLUSION:No cerebral dominance is shown in higher somatic sensations(substance sensation,stereognosis,weight sensation,painting and calligraphy, nd skin moving direction sensation).