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[丘脑梗死——临床症状、神经心理学发现、预后]

[Thalamic infarcts--clinical aspects, neuropsychological findings, prognosis].

作者信息

Büttner T, Schilling G, Hornig C R, Dorndorf W

机构信息

Neurologische Klinik, Ruhr-Universität im St. Josef-Hospital Bochum.

出版信息

Fortschr Neurol Psychiatr. 1991 Dec;59(12):479-87. doi: 10.1055/s-2007-1000723.

Abstract

Results of clinical investigations and CCT of 23 patients with thalamic infarctions were evaluated retrospectively. Nineteen patients underwent a clinical and 15 a neuropsychological examination one to 5 years after their stroke. Regarding the affected vascular territory, the patients were divided into the following subgroups: paramedian infarctions (posterior thalamo-subthalamic arteries, 13 patients, among them 5 bilateral infarcts); anterolateral infarcts (tuberothalamic arteries, 5 patients); posterolateral infarcts (thalamo-geniculate arteries, 5 patients). The leading symptoms of paramedian thalamic infarcts were disturbance of consciousness, amnesia and vertical gaze palsy. The patients with anterolateral thalamic infarctions became acutely confused and disorientated, whereas those with posterolateral infarcts suffered from focal neurological deficits in the first place. Five patients with leftsided thalamic infarctions of varying localization were aphasic. Two patients died within the observation period. A slight hemiparesis was detected in two patients and a vertical gaze palsy in 4, respectively, by the neurological reexamination one to 5 years after the stroke, whereas the clinical findings in 11 patients were completely normal. However 5 patients had a chronic psychosyndrome. The neuropsychological examination showed in some cases disorders of visual retention and verbal function as well as deficits in concentration. Neither the character nor the degree of the neuropsychological deficits did depend on the affected vascular territory but on the existence of further cerebral infarcts on CT-scan.

摘要

对23例丘脑梗死患者的临床研究结果和头颅CT检查结果进行了回顾性评估。19例患者在中风后1至5年接受了临床检查,15例接受了神经心理学检查。根据受累血管区域,将患者分为以下亚组:旁正中梗死(丘脑后下-底丘脑动脉,13例患者,其中5例为双侧梗死);前外侧梗死(丘脑结节动脉,5例患者);后外侧梗死(丘脑膝状体动脉,5例患者)。旁正中丘脑梗死的主要症状为意识障碍、失忆和垂直凝视麻痹。前外侧丘脑梗死患者会急性出现意识模糊和定向障碍,而后外侧梗死患者首先出现局灶性神经功能缺损。5例不同部位左侧丘脑梗死患者出现失语。2例患者在观察期内死亡。中风后1至5年的神经学复查发现,2例患者有轻度偏瘫,4例有垂直凝视麻痹,而11例患者的临床检查结果完全正常。然而,5例患者有慢性精神综合征。神经心理学检查在某些情况下显示视觉记忆和语言功能障碍以及注意力缺陷。神经心理学缺陷的性质和程度均不取决于受累血管区域,而是取决于CT扫描上是否存在其他脑梗死。

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