肢体抖动短暂性脑缺血发作(LS-TIA)的临床及影像

目的 肢体抖动短暂性脑缺血发作（LS-TIA）临床少见,本文旨在提高临床医师对这一症候的认识.方法 总结北京协和医院诊断为肢体抖动短暂性脑缺血发作患者7例,行颈部血管超声、脑电图、头部核磁共振、经颅多普勒超声、核磁血管成像,4例行数字减影血管造影,2例行CT灌注成像检查.结果 均表现为发作性短暂不能控制的抖动,5例发作有明显诱因.全部患者均有抖动肢体对侧至少1条以上颅内和/或颅外动脉重度狭窄或闭塞.头部核磁共振4例显示抖动肢体对侧内分水岭脑梗死.脑电图均未见痫样放电,6例可见病变血管同侧额颞部慢波灶.经扩容和抗血小板聚集或者血管内支架治疗后,所有患者病情稳定.结论 肢体抖动短暂性脑缺血发作通常提示大血管严重的狭窄或闭塞,低灌注是其最可能的发病机制.

Clinical and imaging manifestations of limb-shaking transient ischemic attacks

Objective Limb-shaking transient ischemic attacks(LS-TIA) is an unusual manifestation of ischemic attacks.It is important to recognize this form of carotid transient ischemic attack.Methods We enrolled 7 patients with LS-TIA.Cervical vascular ultrasound,transcranial Doppler,magnetic resonance angiography(MRA),Brain magnetic resonance imaging(MRI)+diffusion weight imaging(DWI) and electroencephalography(EEG) were performed in all patients.Digital substract angiography(DSA) was performed in 4 patients and CT perfusion imaging was performed in 2 patients.Results The basic features included a paroxysmal,brief,involuntary limb shaking which last about several seconds to a minute and the upper extremities involvement were most common.Five patients had obvious precipitating factors.The contralateral internal cervical artery or middle cerebral artery showed critical stenosis or occluded in all 7 patients.The brain MRI showed typical internal watershed cerebral infarction in 4 patients.EEG studies failed to show epileptiform activity associated with LSS,but 6 patients had focal frontotemporal lobe slow activity (indicating ischemia), which was consistent with hypoperfusion area.The antiplatelet drugs,volume dilution therapy or percutaneous angioplasty were administered in 7 patients,all of them were ineventful.Conclusion Usually,the patients with LS-TIA almost invariably have severe carotid occlusive disease and are at high risk of stroke. Hypoperfusion may be the mechanism of pathogenesis.