急性岛叶梗死综合征临床研究

Acute Insular Infarct Syndrome:20 Cases Report

目的探讨岛叶梗死综合征的神经系统症状、体征、病变部位的分布及其对心血管系统的影响。方法选择首次急性发病的岛叶梗死综合征患者20例,分析其神经系统症状及体征、病变部位的分布特点,以及患者血管情况和血流动力学的改变。在脑梗死的急性期进行心电图及Holter监测,分析岛叶梗死对心脏植物神经系统的影响。结果临床表现为高级智能活动减退、语言障碍、偏瘫、感觉障碍及假性前庭症状,梗死部位累及岛叶的同时颞叶受累多见(占65%)。患者入院后24小时内心电图ST段下移发生率最高。Holter监测表明,室上性早搏多见于无心房纤颤的左侧岛叶梗死综合征,心率变异性分析显示R-R间期的标准差(SDNN)降低,相邻R-R间期差值的均方根(RMSSD)升高。结论岛叶梗死综合征表现为高级智能活动减退、语言障碍、偏瘫、感觉障碍及假性前庭症状症候群。左侧岛叶梗死引发复杂的心律失常,左侧岛叶梗死不良心脏转归事件的风险更加严重。岛叶梗死综合征发生与脑岛三角区动脉血液供应特征有关。

Objective To investigate the symptoms, signs and distribution of focus in acute insular infarct syndrome, as well as the effects on cardiovascular system. Methods The clinical manifestations of 20 patients with first event acute insular infarct syn drome were analyzed retrospectively. Results All the patients revealed the intellectual deterioration, aphasia, hemiparalysis, sensory disorder and vestibular-like symptoms. The temporal lobes were mostly involved （65%）. Electrocardiogram showed ST segment de pressed mostly. The supraventrieular premature beats were the most frequence finding by Holter monitoring in left insular infarction except atrial fibrillation, and their heart rate variability indicated that the standard deviation of normal-to-normal intervals （SDNN） decreased, but root mean square successive difference （RMSSD） increased. Conclusion The insular infarct syndrome can be charactered as a group of symptoms of intellectual deterioration, aphasia, hemiparalysis, sensory disorder and vestibular like symptom. Left insular infarct could be complicated with arrhythmia, which increases the risk of adverse cardiac outcome. The characteristics of arteries to Sylvian angle may be associated with the syndrome.