Murahara Takashi, Takaya Shigetoshi, Yamaguchi Daisuke, Tanaka Tomohiro, Fukuyama Hidenao, Ikeda Akio, Takahashi Ryosuke
Department of Neurology, Graduate School of Medicine, Kyoto University
Rinsho Shinkeigaku. 2011 May;51(5):338-44. doi: 10.5692/clinicalneurol.51.338.
The pathophysiology of convulsive movements in patients with convulsive syncope remains unclear. Here, we report a patient with convulsive syncope whose convulsive movements seemed to be associated with transient hemodynamic ischemia in the basal ganglia. A 74-year-old man had 1-year history of orthostatic hypotension and transient clonic jerks in the limbs and trunk, predominantly in the right upper limb. His convulsive movements were evoked approximately 1 minute after sitting up or standing up from the supine position and lasted for several tens of seconds. He felt mild faint while the convulsive movements lasted, but he was oriented and could follow simple commands. He was diagnosed as pure autonomic failure. Video-electroencephalogram (EEG) recorded generalized slows without any epileptiform discharges when the symptoms appeared. Single-photon emission computed tomography (SPECT) was performed using split-dose method to evaluate the change in blood flow when the convulsive movements appeared. During symptoms, a significant decrease in blood flow was revealed in the anterior part of the left basal ganglia, bilateral frontal areas, and right cerebellar hemisphere. An alteration in the functional balance between the basal ganglia and the cerebral cortices may play a role in the generation of convulsive movements in patients with convulsive syncope.
惊厥性晕厥患者惊厥性运动的病理生理学仍不清楚。在此，我们报告一例惊厥性晕厥患者，其惊厥性运动似乎与基底节区短暂性血流动力学缺血有关。一名74岁男性有1年体位性低血压病史，四肢和躯干出现短暂性阵挛性抽搐，主要累及右上肢。他的惊厥性运动在从仰卧位坐起或站立后约1分钟诱发，持续数十秒。惊厥性运动持续时他感到轻度头晕，但意识清楚，能听从简单指令。他被诊断为单纯自主神经功能衰竭。症状出现时，视频脑电图（EEG）记录到广泛性慢波，无任何癫痫样放电。采用分剂量法进行单光子发射计算机断层扫描（SPECT），以评估惊厥性运动出现时的血流变化。症状发作时，左侧基底节区前部、双侧额叶区域和右侧小脑半球血流显著减少。基底节区与大脑皮质之间功能平衡的改变可能在惊厥性晕厥患者惊厥性运动的发生中起作用。
