脑梗死后偏侧空间忽略症患者不同感觉通道和空间参考框架的表现及其康复治疗效果

目的观察1例右侧半球大面积脑梗死所致偏侧空间忽略症患者的不同感觉通道、空间参考框架的表现,以及行为学和经颅磁刺激（TMS）治疗后的效果。方法采用行为学忽略测试中的线条划销、字母划销、星星划销、二分线段测试评定患者的视觉通道,临摹左右并列的2个图形测试患者的空间参考框架特点。同时进行听觉通道（左、右耳听手指撮捻声）、触觉通道（左、右手指被碰触）的偏侧空间忽略症检查。采用常规行为学和低频TMS刺激左半球顶下小叶进行2周（10次,1次/d,20 min/次）的偏侧空间忽略症治疗。结果①该患者治疗前的线条划销、字母划销、星星划销测试均显示,左侧空间内完成划销的数量低于右侧空间,差异有统计学意义,P〈0.01。二分线段测试也表现为标记的中点明显偏右。②图形临摹显示患者不仅忽略了左侧空间的刺激（物体）,也忽略了右侧空间内刺激（物体）的左半内容。③听觉通道、触觉通道忽略症检查也显示,对于左侧空间的听觉、触觉刺激的探查能力低于右侧,差异有统计学意义,P〈0.01。④经2周治疗后,患者划销测试和图形临摹均较治疗前得到改善（P〈0.05,P〈0.01）。结论右侧半球大面积脑梗死可导致不同感觉通道和空间参考框架的偏侧空间忽略症。两周行为学和低频TMS治疗对改善偏侧空间忽略症有效。

Performance of different sensory modalities and spatial frames of reference and the effect of rehabilitation in a patient with unilateral spatial neglect symptom

Objective To observe the performance of different sensory modalities and spatial frames of reference in a patient with massive right cerebral infarction and the effects after the behavioral treatment and transcranial magnetic stimulation(TMS).Methods The line cancellation,letter cancellation,star cancellation and line bisection test in the Behavioral Inattention Test(BIT),as well as the copying test of left-right parallel graphics were used.The unilateral spatial neglect examination was also conducted for the auditory modality(both ears hearing the twist with fingers) and tactile modality(left and right hand fingers being touched) at the same time.Conventional behavior and low-frequency TMS stimulating left posterior parietal lobe were used for the treatment of unilateral spatial neglect for two weeks.Results ①The patient’s line cancellation,letter cancellation and star cancellation tests before treatment all showed that the numbers of completing cancellation in the left space were lower than those in the right space.There was significant difference(P<0.01).The line bisection test also showed that the marked midpoint obviously turned to the right.②The graphic copy showed that the patient not only neglected the stimulation(objects) in the left space,but also neglected left half of the stimulation(objects)in the right space.③The auditory and tactile modality tests also showed that detection capabilities of the auditory and tactile stimulation in the left space were significantly lower than those in the right space.There was significant difference(P<0.01).④The cancellation test and graphic copy of the patient were improved after two-week treatment,(P<0.05,P<0.01).Conclusion The large cerebral infarction of right hemispher may result in unilateral spatial neglect in different sensory modalities and spatial frames of reference.Two weeks of behavioral and low-frequency TMS therapy are effective for improving the unilateral spatial neglect symptom.