Hermann Dirk M, Siccoli Massimiliano, Brugger Peter, Wachter Karen, Mathis Johannes, Achermann Peter, Bassetti Claudio L
Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, CH-8091 Zürich, Switzerland.
Stroke. 2008 Jan;39(1):62-8. doi: 10.1161/STROKEAHA.107.494955. Epub 2007 Nov 29.
The clinical features and natural course of paramedian thalamic stroke is poorly known. The aim of this study was to characterize the evolution of neurological, neuropsychological, and sleep-wake deficits after paramedian thalamic stroke.
Forty-six consecutive patients, aged 48.4+/-16.6 years, were studied. Fourteen had bilateral, 16 left-sided, and 16 right-sided lesions. Assessment included neurological examinations, estimation of sleep needs, formal neuropsychological tests (n=27), and polysomnographies (n=31). Functional outcome was followed up over 1 year in 31 patients with the modified Rankin Scale and Barthel index.
Oculomotor palsy (76% of patients), mild gait ataxia (67%), deficits of attention (63%), fluency and error control (59%), learning and memory (67%), and behavior (67%) were common in the acute stroke phase. Outcome was excellent with right-sided infarcts but mostly incomplete with bilateral and left-sided lesions. This was mainly related to persistent frontal lobe-related and cognitive deficits found in 100% bilateral and 90% left-sided, but only 33% right-sided strokes. Initially, hypersomnia was present in all patients associated with increased stage 1 sleep, reduced stage 2 sleep, and reduced sleep spindles. Sleep needs improved in patients with bilateral and almost disappeared with unilateral lesions after 1 year. Sleep architecture remained abnormal with the exception of sleep spindles that increased.
Whereas neurological deficits and hypersomnia recover to large extent in patients with paramedian thalamic stroke, the frontal lobe-related and cognitive deficits, which are mainly linked with bilateral and left-sided lesions, often persist. As such, stroke outcome is better in right-sided than bilateral or left-sided infarcts.
旁正中丘脑卒中的临床特征及自然病程鲜为人知。本研究旨在描述旁正中丘脑卒中后神经、神经心理及睡眠-觉醒功能障碍的演变过程。
对46例连续患者进行研究，年龄为48.4±16.6岁。其中14例为双侧病变，16例为左侧病变，16例为右侧病变。评估内容包括神经学检查、睡眠需求评估、正规神经心理学测试（n = 27）及多导睡眠图检查（n = 31）。31例患者采用改良Rankin量表和Barthel指数对功能结局进行了为期1年的随访。
动眼神经麻痹（76%的患者）、轻度步态共济失调（67%）、注意力缺陷（63%）、语言流畅性和错误控制缺陷（59%）、学习和记忆缺陷（67%）以及行为缺陷（67%）在急性卒中阶段较为常见。右侧梗死患者预后良好，但双侧和左侧病变患者大多预后不完全。这主要与100%的双侧和90%的左侧卒中患者存在持续性额叶相关及认知缺陷有关，而右侧卒中患者仅为33%。最初，所有患者均出现嗜睡，伴有1期睡眠增加、2期睡眠减少及睡眠纺锤波减少。双侧病变患者的睡眠需求有所改善，单侧病变患者1年后睡眠需求几乎消失。除睡眠纺锤波增加外，睡眠结构仍异常。
旁正中丘脑卒中患者的神经功能缺陷和嗜睡在很大程度上可恢复，但主要与双侧和左侧病变相关的额叶相关及认知缺陷往往持续存在。因此，右侧梗死患者的卒中结局优于双侧或左侧梗死患者。
