Nowak Dennis A, Gumprecht Hartmut, Topka Helge
Department of Psychiatry III, University of Ulm, Leimgrubenweg 12, 89075, Ulm, Germany.
J Neurol. 2006 May;253(5):640-7. doi: 10.1007/s00415-006-0086-2. Epub 2006 Feb 7.
Apart from the classic triad of hypokinetic gait disorder, cognitive dysfunction and urinary incontinence, the clinical spectrum of normal pressure hydrocephalus has been found to affect the upper limbs. It is unclear if the motor deficit of hand and arm movements improves with CSF evacuation. The present study was designed to quantitatively assess the effect of CSF evacuation on the hypokinesia of grasping movements in normal pressure hydrocephalus. Eight subjects with normal pressure hydrocephalus grasped to lift an instrumented object prior to and following evacuation of 40 ml CSF. The build-up of fingertip forces and the kinematics of the lifting movement were slower for patients compared with healthy controls. Patients also generated excessive grasping forces when lifting and holding the object stationary prior to and following CSF evacuation. CSF evacuation significantly improved the gait disorder, the cognitive impairment and the urinary incontinence in normal pressure hydrocephalus. CSF evacuation accelerated the lifting movement and reduced the grip force overshoot. These data suggest that the measurement of grasping forces may provide an additional test to quantify the clinical response to CSF tapping in normal pressure hydrocephalus.
除了运动功能减退性步态障碍、认知功能障碍和尿失禁这一典型三联征外，还发现正常压力脑积水的临床谱会影响上肢。目前尚不清楚脑脊液引流后手部和手臂运动的运动功能缺损是否会改善。本研究旨在定量评估脑脊液引流对正常压力脑积水患者抓握运动减退的影响。8名正常压力脑积水患者在引流40毫升脑脊液之前和之后抓握并提起一个装有仪器的物体。与健康对照组相比，患者指尖力量的增强以及提起动作的运动学表现较慢。在脑脊液引流之前和之后，患者在提起并保持物体静止时也会产生过大的抓握力。脑脊液引流显著改善了正常压力脑积水患者的步态障碍、认知障碍和尿失禁。脑脊液引流加快了提起动作并减少了握力过冲。这些数据表明，抓握力的测量可能为量化正常压力脑积水患者对脑脊液穿刺的临床反应提供一项额外的测试。
