老年患者肢体抖动性短暂性脑缺血发作的临床分析

Transient cerebral ischemia in elderly patients with limb shaking

目的分析肢体抖动性短暂性脑缺血发作患者的临床和影像学特点,优化检查和治疗,减少误诊。方法选择肢体抖动性短暂性脑缺血发作患者5例,分析其临床特点,所有患者均进行经颈部血管超声、头颅MRI和磁共振血管成像检查,其中2例行头颈部联合CT血管造影检查、1例行数字减影血管造影检查,1例行单光子发射计算机断层摄像检查,3例行脑电图检查,并进行分析。结果 3例表现为发作性肢体抖动,2例表现为肢体力弱合并肢体抖动,抖动肢体对侧有不同程度的血管狭窄或闭塞,给予扩容、抗血小板聚集治疗后,症状好转。结论临床遇到发作性肢体抖动、特别是在肢体力弱的基础上合并肢体抖动,要考虑到肢体抖动性短暂性脑缺血发作的可能,该类患者常常存在严重的颅内外血管狭窄,扩容、抗血小板聚集治疗有效。

Objective To optimize the examination and treatment of transient cerebral ischemia and reduce its misdiagnosis in elderly patients with limb shaking by analyzing its clinical and imaging characteristics. Methods Clinical features of transient cerebral ischemia in 5 patients with limb shaking were analyzed. Of the 5 patients who underwent cervical ultrasonography,head MRI and angiography,2 underwent cephalo-cervical and CT angiography, 1 underwent digital subtraction angiography, 1 underwent simple photon transmission CT, and 3 underwent encephalography, and their findings were analyzed. Results Of the 5 patients,3 were found to have paroxysmal limb shaking and 2 were found to have a weak strength of the limbs accompanying limb shaking. After expansion of the vascular stenosis and occlusion and antiplatelets treatment, the symptoms of those with limb shaking were improved. Conclusion Transient cerebral ischemia should be considered when limb shaking is found in patients with crebrovascular stenosis, especially in those with a weak limb strength. Vascular expansion and antiplatelets therapy are the effective treatment modalities for it.