肢体抖动性短暂性脑缺血发作临床分析

目的探讨肢体抖动性短暂性脑缺血发作的临床表现及诊断,提高临床医师对这一症候的认识。方法采用动态脑电图、经颅多普勒超声、颈部血管超声、头部核磁共振、核磁共振血管成像、全脑血管造影等辅助检查,对4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4例患者均表现为肢体发作性短暂不能控制的抖动,其发作均有明显诱因,其中2例曾被误诊为癫,给予抗癫治疗无效。全部患者均有抖动肢体对侧至少1条以上颅内和（或）颅外动脉严重狭窄或闭塞,头部核磁共振3例显示抖动肢体对侧分水岭脑梗死,发作期脑电图检查未见癫波释放,给予抗血小板聚集、扩容或者血管内支架治疗后,症状均消失。结论肢体抖动性短暂性脑缺血发作常表现为发作性、无意识的肢体抖动,和局灶性运动性癫发作相似,易误诊为局灶性癫,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,通过脑电图及全脑血管造影等检查可以明确诊断,防止漏诊及误诊。

Clinical analysis of limb-shaking transient ischemic attacks

Objective To approach limb-shaking transient ischemic attacks clinical features and diagnosis by history and examination of 4 typical patients with review literature,aiming to warn physicians about this sign.Methods Video-electroencephalography(EEG),transcranial Doppler,cervical vascular ultrasound,brain magnetic resonance imaging(MRI),magnetic resonance angiography(MRA) and digital subtract angiography(DSA) were peincluded formed in 4 patients.The clinical features,examination and neuroimage data were analyzed.Results The clinical features included a paroxysmal,brief,involuntary limb-shaking.All patients had obvious precipitating,2 patients were misdiagnosed as epilepsy.And antiepileptic had no effect.The contralateral internal cervical artery or middle cerebral artery showed critical stenosis or occlusion.In all 4 patients,the brain MRI showed typical watershed cerebral infarction in 3 patients,video-EEG studies failed to show epileptiform activity.The antiplatelet drugs,volum dilution therapy or percutaneous angioplasty were administered in 4 patients.All of them became asymptomatic.Conclusion The clinical feature of limb-shaking transient ischemic attacks is paroxysmal unconscious limb shaking.It is sometimes mistaken for focal motor seizure,because of its similar appearance.The patients with limb-shaking transient ischemic attacks almost invariably have severe carotid senosis or occlusion.Hypoperfusion may be the mechanism of pathogenesis.It could be recognized by EEG and DSA examination.