肢体抖动性短暂性脑缺血发作临床分析

目的 通过3例典型患者的病史和辅助检查，结合文献复习，探讨肢体抖动性短暂性脑缺血发作的临床表现及诊断，以提高诊断的准确率。方法 采用动态脑电图、超声多普勒、磁共振成像、磁共振动脉血管造影、全脑血管造影等辅助检查，对3例肢体抖动性短暂性脑缺血发作患者进行临床表现、辅助检查及影像学资料分析。结果 3例患者均有肢体抖动的临床表现，其中2例曾被误诊为继发性癫痫，给予抗癫痫治疗无效，行全脑血管造影、脑电图等检查。全脑血管造影提示3例颈内动脉系统均存在严重闭塞或狭窄性病变，而发作期脑电图检查未见癫痫波释放。给予抗血小板聚集等药物治疗，但仍偶有发作。2例施行血管内支架植入术后发作完全停止，1例由于血管迂曲明显，手术未获成功，经内科保守治疗症状缓解出院。结论 肢体抖动性短暂性脑缺血发作为临床少见短暂性脑缺血发作，其发作形式常表现为发作性、无意识的一侧肢体无力及抖动，和局灶性运动性癫痫发作相似，易误诊为局灶性癫痫。通过脑电图及全脑血管造影等检查可以明确诊断，从而提高对该病诊断的准确率，防止漏诊及误诊。

Clinical analysis of limb shaking TIAs

Objective To study the clinical manifestations and diagnosis in three patients with limb shaking transient ischemic attacks (LSTIA) in order to improve the diagnostic accuracy of this disorder. Methods Three cases with LSTIA were systematically studied by using active electroencephalogram, transcranial Doppler (TCD), magnetic resonance imaging(MRI), magnetic resonance angiography (MRA) and cerebral angiography. Results Attacks with transient limb shaking were unilateral in all the three patients. Two patients among them were misdiagnosised as secondary focal motor epilepsy but the symptoms did not disappear after treatment with anti-epileptics. Internal carotid arteries showed occlusions or stenosis in cerebral angiography and active electroencephalogram was normal in all the three patients. Symptoms still occurred occasionally after treatment with antiplatelet drugs, two of the patients were performed left carotid artery and middle cerebral artery endovascular stenting placement respectively then symptoms completely disappeared. Another one patient was failed in stenting placement and showed symptomatic relief by medicine conservative treatment. Conclusion Limb shaking transient ischemic attack is a clinically rare disorder characterized of transient ischemic attack with paroxysmal onset and unconscious shaking of unilateral extremity. Its symptoms are similar to the focal motor epilepsy and easily misdiagnosed as focal epilepsy. But this disease might be definitely diagnosed by EEG and cerebral angiography, such measures would improve the diagnostic accuracy and prevent from misdiagnosis.