单侧丘脑-中脑结合部梗死致垂直一个半综合征1例

A case of unilateral thalamic-midbrain junction infarction presenting with the vertical"one-and-a-half"syndrome

本文报告1例以垂直一个半综合征为临床表现的典型病例。患者男,62岁,入院时表现为言语不利伴右侧肢体活动不灵,颅脑CT排除脑出血,给予静脉溶栓治疗后症状消失,溶栓24 h后出现左眼上下凝视麻痹,右眼上视不能,完善颅脑MRI+MRA示左侧丘脑-中脑结合部新发脑梗死、左侧大脑后动脉P1段狭窄,予以抗血小板聚集、调脂稳斑等治疗后好转出院,出院后1个月随访垂直复视症状完全消失。垂直一个半综合征临床上相对少见,通过分析本例患者的临床表现及损伤结构,以提高临床医生对本病的认识和定位诊断能力。

This paper reports a typical case of vertical"one-and-a-half"syndrome caused by unilateral thalamicmidbrain junction infarction.A 62 year-old male patient presented with adverse speech and right limb impairment.Intravenous thrombolysis treatment was given after exclusion of cerebral hemorrhage by CT scan.Symptoms were resolved shortly after thrombolysis.However,the patient exhibited complete vertical gaze palsy of left eye and upward gaze palsy of right eye 24 hours later.Brain MRI+MRA showed left thalamic-midbrain junction fresh cerebral infarction and left posterior cerebral artery P1 stenosis.His symptoms were significantly improved after treatment with antiplatelet aggregation and lipid stabilization plaque.The vertical diplopia symptoms were completely resolved one month after discharge.Given that vertical"one-and-a-half"syndrome is relatively rare clinically,reporting this case with the clinical manifestations and brain lesion can increase the awareness and improve diagnostic skill of clinicians.