抖动型短暂性脑缺血发作患者的病因分析

Etiology analysis of limb shaking in transient ischemic attack patients

目的探讨抖动型短暂性脑缺血发作(TIA)患者的临床表现、病因及其可能机制。方法对11例抖动型TIA患者的临床表现、辅助检查结果进行回顾性分析。结果11例患者均表现为1侧肢体或单肢反复抖动发作,其中2例抖动发作时伴随抖动肢体不自主运动。MRI检查提示3例有大脑中动脉(MCA)分水岭区梗死。血管检查提示8例有抖动肢体对侧MCA中度狭窄,6例有抖动肢体对侧颈内动脉严重狭窄或颈总动脉与颈内动脉的串联狭窄。CT灌注显像及MRI灌注成像显示抖动肢体对侧MCA区低灌注。脑电图检查未见癫痫波。患者经血管内支架成形术或适当药物治疗后症状消失。结论抖动型TIA与颅内外动脉狭窄造成MCA分布区脑血流的低灌注有关,增加血流灌注可使发作减少或停止。

Objective To identify clinical characteristics, etiology and mechanism of limb shaking in patients with transient ischemic attack（TIA）. Methods A retrospective study was performed in eleven patients with shaking TIA. Clinical manifestations and laboratory examination results including transcanial Doppler ultrasound, cervical artery ultrasound, magnetic resonance image （MRI） and MRA and digital subtraction angiography （DSA） were analyzed. Results The paroxysmal and temporal attacks involved limbs of one side or single extremity, with involuntary movement in 2 patients. MRI showed border zone infarcts between middle cerebral artery （MCA） and anterior cerebral artery or posterior cerebral artery in 3 patients. Ultrasound and DSA found moderate stenosis of contralateral MCA in 8 patients. Six patients had severe stenosis of contralateral internal carotid artery or stenosis of both common and internal carotid arteries. CT perfusion and single photon emission computerized tomography （SPECT） showed perfusion deficit in frontal, temporal and parietal cortex of con- tralateral MCA region. No epileptic spikes in all electroencephalogram examinations. Symptoms disappeared after endovascular stenting and antiplatelet therapy. Conclusions Shaking TIA is associated with perfusion deficit in MCA territory caused by intra or extra cranial artery stenosis. Attacks would be reduced or ceased by improving focal blood flow.