Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
Neurology. 2010 Feb 9;74(6):458-64. doi: 10.1212/WNL.0b013e3181cef647.
Balance impairment is common following cerebral infarction. However, the effects of lesion hemisphere on postural control are largely unknown. We examined dependence upon vision and noninfarcted regional brain tissue volumes for postural control in individuals with right and left hemisphere middle cerebral artery (MCA) infarcts.
Subjects with right MCA infarct (n = 17, age = 65 +/- 8 years, 7 +/- 6 years poststroke), left MCA infarct (n = 20, age = 65 +/- 8 years, 7 +/- 6 years poststroke), and controls (n = 55, age = 65 +/- 8 years) were studied. Postural control was defined by average velocity and the range and variability of mediolateral (ML) and anteroposterior (AP) sway during eyes-open and eyes-closed standing. Regional brain volumes were quantified using anatomic MRI at 3 Tesla.
Right and left hemisphere stroke groups had similar infarct volumes and outcomes. Subjects with right hemisphere infarcts demonstrated greater sway velocity, ML range, and ML variability with eyes closed compared to eyes open. In this group, smaller occipital lobe volumes were associated with greater eyes-open sway velocity (R = -0.64, p = 0.012) and ML range (R = -0.82, p = 0.001). Smaller cerebellar volumes were associated with greater eyes-closed sway velocity (R = -0.60, p = 0.015), ML range (R = -0.70, p = 0.007), and ML variability (R = -0.85, p < 0.001). These associations were not observed in left hemisphere infarct subjects or controls. AP sway was unaffected by infarct hemisphere or visual condition and did not correlate with regional brain volumes.
Right hemisphere middle cerebral artery infarcts are associated with increased dependence on vision and noninfarcted brain regions (i.e., occipital lobes, cerebellum) to control postural sway. Strategies emphasizing postural tasks under reduced visual conditions may enhance functional recovery in these individuals.
脑梗死患者常出现平衡障碍。然而，病变半球对姿势控制的影响尚不清楚。我们检测了右和左大脑中动脉（MCA）梗死患者依赖于视觉和未梗死区域脑体积的姿势控制情况。
研究了右 MCA 梗死（n=17，年龄=65±8 岁，卒中后 7±6 年）、左 MCA 梗死（n=20，年龄=65±8 岁，卒中后 7±6 年）和对照组（n=55，年龄=65±8 岁）的受试者。姿势控制通过睁眼和闭眼站立时的平均速度以及前后（AP）和侧向（ML）摆动的范围和变异性来定义。使用 3T 解剖 MRI 量化区域脑体积。
右和左半球卒中组的梗死体积和结局相似。右半球梗死患者闭眼时的摆动速度、ML 范围和 ML 变异性大于睁眼时。在该组中，枕叶体积较小与睁眼时的摆动速度（R=-0.64，p=0.012）和 ML 范围（R=-0.82，p=0.001）增加相关。小脑体积较小与闭眼时的摆动速度（R=-0.60，p=0.015）、ML 范围（R=-0.70，p=0.007）和 ML 变异性（R=-0.85，p<0.001）增加相关。这些关联在左半球梗死患者或对照组中未观察到。AP 摆动不受梗死半球或视觉条件的影响，与区域脑体积无关。
右 MCA 梗死与对视觉和未梗死区域（即枕叶、小脑）控制姿势摆动的依赖性增加有关。在这些患者中，强调在减少视觉条件下进行姿势任务的策略可能会增强其功能恢复。
