肢体抖动性短暂性脑缺血发作10例临床分析

Clinical analysis on 10 cases of limb-shaking transient ischemic attacks

目的研究肢体抖动性短暂性脑缺血发作(Limb-shaking transient ischemic attacks,LS-TIA)的临床特点和预后。方法 2009年7月至2010年12月两家三甲医院前瞻性卒中登记库中连续性LS-TIA的患者,研究其TIA特点、头颅影像学表现,并予以药物和/或支架置入治疗,随访1年时用改良的Rankin评分(mRS)。结果共纳入10例LS-TIA患者,多于活动时诱发(7例),以下肢抖动(8例)伴无力(7例)为主要表现,持续时间<5min,颈内动脉重度狭窄(7例)和大脑中动脉狭窄(3例),MRI仅2例显示分水岭脑梗死,8例示腔隙性脑梗死,4例颈动脉颅外段狭窄经过药物联合支架治疗,5例颅内血管狭窄经过强化药物治疗随访1年mRS为0分,1例颈动脉起始段重度狭窄单纯药物治疗,1个月后发生同侧脑梗死,1年后mRS为4分。结论对于MRI仅显示腔隙性脑梗死的肢体抖动患者需警惕为LS-TIA,对颅外颈动脉狭窄的LS-TIA支架置入治疗和颅内动脉狭窄的LS-TIA采取积极的药物具有较好的预后。

Objective To explore the clinical features and prognosis of the limb-shaking transient ischemic attacks （LS-TIA）. Methods Ten patients with LS-TIA in two third-grade A-level hospitals from Jul. 2009 to Dec. 2010 were studied for their TIA characteristics and cranial imaging. The patients were treated with antiplatelet drugs and/or interventional therapies, and followed up for 1 year. Modified Rankin Scale （mRS） was used to evaluate the clinical efficacy. Results Of the 10 patients, 7 were induced by activity. Eight of the patients had the lower limbs shaking with duration of less than 5 minutes and 7 had concomitant weakness. Seven patients were found with internal carotid artery severe stenosis and 3 with middle cerebral artery stenosis. Two cases of cranial MRI revealed watershed infarction and the remaining 8 cases showed lacunar infarction lesions. Four patients with extracranial carotid severe stenosis were given antiplatelet, statins drugs and carotid artery stenting, and 5 patients of intraeranial vascular steno- sis were administered aggressive drugs including two antiplatelet and statins drugs. The above 9 patients were fol- lowed up for 1 year and the mRS were 0. One case with the severe stenosis of carotid artery was only given drugs and islateral ischemie stroke occurred after 1 month, with mRS of 4. Conclusion The patients with limb shaking and with MRI showing lacunar infarction lesion need to be alert for LS-TIA. Stenting for extracranial carotid stenosis and aggressive drugs for intracranial arteries stenosis may reach better long-term outcomes.