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丘脑梗死伴 Cajal 间质核功能障碍所致步态平衡障碍

Gait balance disorder by thalamic infarction with the disorder of interstitial nucleus of cajal.

作者信息

Kurosu A, Hayashi Y, Wada K, Nagaoka M

机构信息

Department of Rehabilitation, Juntendo University Nerima Hospital, Nerima, Tokyo 177-8521, Japan.

出版信息

Clin Med Insights Case Rep. 2011;4:7-11. doi: 10.4137/CCRep.S6232. Epub 2011 Feb 17.

DOI:10.4137/CCRep.S6232
PMID:21769260
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3096434/
Abstract

The interstitial nucleus of Cajal (INC) is thought to play an important role in torsional/vertical eye position and head posture, and disorders of the INC induce abnormal ocular movements and head tilt. Our patients with ocular tilt reactions simultaneously also had disturbances in ambulatory balance, yet no reports address the loss of balance control induced by disorders of the INC. We examined the ambulatory disturbances induced by INC lesion. We experienced three patients with ocular movement disorders and abnormal head tilt due to thalamic infarction. We performed ophthalmic examinations on and checked the balance of them. With funduscopy, abnormal cycloduction was seen in the unaffected side and normal cycloduction was observed in the affected side. Nevertheless, Hess charts showed distortions in the visual image of both eyes. They all had disorders of balance control. We tried to treat them using the Bobath approach for improving their ambulatory balance. With subsequent improvements in balance control it was possible for them to take short walks, but it was difficult to make any improvements in their ocular movement. The INC is related to balance control of ambulation and disorders of the INC induce ambulatory disturbances. Cycloduction was only observed in the unaffected side, but Hess charts showed distortions of the visual image in both eyes. Ambulation was briefly improved, but diplopia persisted in these patients.

摘要

Cajal间质核（INC）被认为在扭转/垂直眼位和头部姿势中起重要作用，INC的病变会导致异常的眼球运动和头部倾斜。我们患有眼倾斜反应的患者同时也存在动态平衡障碍，但尚无报告涉及INC病变引起的平衡控制丧失。我们研究了INC损伤引起的动态障碍。我们遇到了3例因丘脑梗死导致眼球运动障碍和异常头部倾斜的患者。我们对他们进行了眼科检查并检查了他们的平衡情况。通过眼底镜检查，在未受影响的一侧可见异常的眼球旋转，而在受影响的一侧观察到正常的眼球旋转。然而，Hess图表显示双眼视觉图像有扭曲。他们都有平衡控制障碍。我们尝试使用Bobath方法治疗他们以改善他们的动态平衡。随着平衡控制的后续改善，他们有可能短距离行走，但很难改善他们的眼球运动。INC与行走的平衡控制有关，INC的病变会导致动态障碍。仅在未受影响的一侧观察到眼球旋转，但Hess图表显示双眼视觉图像有扭曲。行走情况有短暂改善，但这些患者仍存在复视。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/244c/3096434/3e79bfdd5a63/ccrep-2011-007f8.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/244c/3096434/b490386b0245/ccrep-2011-007f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/244c/3096434/2d8f296ae986/ccrep-2011-007f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/244c/3096434/6a8f7a261b26/ccrep-2011-007f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/244c/3096434/97d224cdff41/ccrep-2011-007f4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/244c/3096434/ce86d9493064/ccrep-2011-007f5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/244c/3096434/80843d58978c/ccrep-2011-007f6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/244c/3096434/61519b694e3d/ccrep-2011-007f7.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/244c/3096434/3e79bfdd5a63/ccrep-2011-007f8.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/244c/3096434/b490386b0245/ccrep-2011-007f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/244c/3096434/2d8f296ae986/ccrep-2011-007f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/244c/3096434/6a8f7a261b26/ccrep-2011-007f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/244c/3096434/97d224cdff41/ccrep-2011-007f4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/244c/3096434/ce86d9493064/ccrep-2011-007f5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/244c/3096434/80843d58978c/ccrep-2011-007f6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/244c/3096434/61519b694e3d/ccrep-2011-007f7.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/244c/3096434/3e79bfdd5a63/ccrep-2011-007f8.jpg

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Stroke. 2009 Apr;40(4):e89-97. doi: 10.1161/STROKEAHA.108.533828. Epub 2009 Jan 29.
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Paroxysmal ocular tilt reactions after mesodiencephalic lesions: report of two cases and review of the literature.中脑间脑病变后阵发性眼倾斜反应：两例报告及文献复习
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Ipsiversive partial ocular tilt reaction in a patient with acute paramedian thalamic infarctions.
一名急性丘脑旁正中梗死患者的同侧偏斜性部分眼倾斜反应
Acta Neurol Taiwan. 2006 Mar;15(1):29-33.
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Vestibular influence on the binocular control of vertical-torsional nystagmus after lesions in the interstitial nucleus of Cajal.Cajal间质核损伤后前庭对垂直扭转性眼球震颤双眼控制的影响
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