Tatemichi T K, Young W L, Prohovnik I, Gitelman D R, Correll J W, Mohr J P
Department of Neurology, Columbia-Presbyterian Medical Center, New York, New York.
Stroke. 1990 Feb;21(2):341-7. doi: 10.1161/01.str.21.2.341.
We describe a 63-year-old man with severe bilateral internal carotid artery disease who presented with repeated, brief attacks of left limb shaking precipitated by his standing up. Cerebral blood flow measured by xenon-133 inhalation showed reduced resting flows and a focal perfusion deficit in the right dorsofrontal and upper rolandic regions. Blood flow velocity and pulsatility index of the right middle cerebral artery measured by transcranial Doppler ultrasonography were also reduced. With hypercapnic challenge, both hemispheric tissue perfusion and blood flow velocity showed impaired reactivity. With induced hypotension, the focal perfusion deficit in the right dorsofrontal region was accentuated. Following right internal carotid endartectomy, resting cerebral blood flow and blood flow velocity improved, as did hypercapnic vasoreactivity. These reversible deficits in cerebral blood flow and vasoregulation, which were maximal in the dorsofrontal region, are consistent with low perfusion in the border zone territory or the distal fields and demonstrate that hemodynamic failure is the likely mechanism for limb-shaking transient ischemic attacks from severe carotid artery disease.
我们描述了一名63岁患有严重双侧颈内动脉疾病的男性，他在站立时会反复出现短暂的左肢震颤发作。通过吸入氙-133测量的脑血流量显示静息血流减少，右背侧额叶和上中央前回区域存在局灶性灌注缺损。经颅多普勒超声测量的右侧大脑中动脉血流速度和搏动指数也降低。在高碳酸血症激发试验中，双侧半球组织灌注和血流速度均显示反应性受损。在诱导性低血压时，右背侧额叶区域的局灶性灌注缺损加剧。右侧颈内动脉内膜切除术后，静息脑血流量和血流速度改善，高碳酸血症血管反应性也改善。这些在背侧额叶区域最为明显的脑血流量和血管调节的可逆性缺损，与边缘区或远隔区域的低灌注一致，并表明血流动力学衰竭可能是严重颈动脉疾病导致肢体震颤短暂性脑缺血发作的机制。
