Grau-Olivares Marta, Arboix Adrià, Bartrés-Faz David, Junqué Carme
Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain.
J Neurol Sci. 2007 Jun 15;257(1-2):160-5. doi: 10.1016/j.jns.2007.01.022. Epub 2007 Feb 20.
The objective of this study was to assess neuropsychological abnormalities in 40 patients with lacunar infarction. Topography of infarction, presence of isolated or multiple silent infarcts and white matter hyperintensities were correlated with results of neuropsychological tests and subtypes of lacunar infarction. Patients were studied within 1 month after stroke. A total of 21 patients were males and the mean age was 70.7 years; 30% had a single infarction (mean number of infarctions was 3.4). Twelve patients had pure motor hemiparesis, 9 pure sensory stroke, 8 dysarthria-clumsy hand/ataxic hemiparesis, 8 atypical lacunar syndrome, and 3 sensorimotor stroke. The mean score of the Mini-Mental State Examination was 28.4. Mild cognitive impairment of subcortical vascular features occurred in 23 patients and isolated executive disturbances in 4. Neuropsychological results showed that patients with atypical lacunar syndrome followed by pure motor hemiparesis showed significantly more cognitive executive disturbances. Patients with dysarthria-clumsy hand/ataxic hemiparesis accounted for the best scores in some tests of visuoconstructive function and visual memory. In summary, mild neuropsychological disturbances (57.5%) are not infrequent in acute lacunar infarcts especially in patients with atypical lacunar syndrome and pure motor hemiparesis. Neuropsychological impairment should be considered as common clinical feature in acute lacunar infarction.
本研究的目的是评估40例腔隙性脑梗死患者的神经心理学异常情况。梗死灶的部位、孤立或多发无症状性梗死灶及白质高信号与神经心理学测试结果及腔隙性脑梗死的亚型相关。患者在卒中后1个月内接受研究。共有21例男性患者，平均年龄为70.7岁；30%的患者有单个梗死灶（平均梗死灶数量为3.4个）。12例患者为纯运动性偏瘫，9例为纯感觉性卒中，8例为构音障碍-手笨拙/共济失调性偏瘫，8例为非典型腔隙综合征，3例为感觉运动性卒中。简易精神状态检查表的平均得分为28.4分。23例患者出现皮质下血管性特征的轻度认知障碍，4例出现孤立的执行功能障碍。神经心理学结果显示，非典型腔隙综合征继以纯运动性偏瘫的患者出现明显更多的认知执行功能障碍。构音障碍-手笨拙/共济失调性偏瘫患者在某些视觉构建功能和视觉记忆测试中得分最高。总之，轻度神经心理学障碍（57.5%）在急性腔隙性脑梗死中并不少见，尤其是在非典型腔隙综合征和纯运动性偏瘫患者中。神经心理学损害应被视为急性腔隙性脑梗死常见的临床特征。
