肢体抖动性短暂性脑缺血发作6例临床分析.docVIP

肢体抖动性短暂性脑缺血发作的临床与预后研究 李其富1，郑洪波2，容琼文1，王埮1，王淑荣1，陈志斌1 （1. 海南医学院附属医院神经内科，海南 海口 570102； 2. 四川大学华西医院神经内科， 四川 成都 610041） 【摘要】 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：纳入2009.07-2010.12两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。 【关键词】肢体抖动性短暂性脑缺血发作；磁共振成像；支架置入术 【中图分类号】R743.31 【文献标识码】　A Clinical features and prognosis of limb-shaking transient ischemic attacks LI Qi-fu1, ZHENG Hong-bo2, RONG Qiong-wen1, WANG Tan1, WANG Shu-rong1, CHEN Zhi-bin1 (Department of Neurology, the Affiliated Hospital of Hainan Medical College, Haikou 570102, China) 【Abstract】 Objective: To explore the clinical features and prognosis of the limb-shaking transient ischemic attacks (LS-TIA). Methods: The characteristics of the TIA and cranial imaging of the successive ten patients with LS-TIA were revealed. All patients were administered antiplatelet drugs and/or interventional therapies and followed up for 1 year. Results: All of the 10 patients had vascular risk factors and 7 were induced by activity. 8 had the lower limbs shaking with duration of less than 5 minutes and 7 had concomitant weakness. 7 were found the internal carotid artery severe stenosis and 3 with the middle cerebral artery stenosis. Only 2 cases of cranial MRI was revealed watershed infarction and the remaining 8 cases showed lacunar infarction lesions. 4 cases with extracranial carotid severe stenosis were given antiplatelet, statins drugs and carotid artery stenting. 5 cases of intracranial vascular stenosis were administered aggressive drugs including two antiplatelet and statins drugs. The above 9 cases were followed up for 1 year and modified Rankin Scale were 0. 1 case wi