中风的临床神经生理学
Clinical neurophysiology of stroke.
作者信息
Gavaret Martine, Marchi Angela, Lefaucheur Jean-Pascal
机构信息
INSERM UMR894, Paris Descartes University, Paris, France; Service de Neurophysiologie Clinique, Centre Hospitalier Sainte Anne, Paris, France.
Service de Neurophysiologie Clinique, Centre Hospitalier Sainte Anne, Paris, France.
出版信息
Handb Clin Neurol. 2019;161:109-119. doi: 10.1016/B978-0-444-64142-7.00044-8.
Stroke constitutes the third most common cause of death and the leading cause of acquired neurologic handicap. During ischemic stroke, very early after the onset of the focal perfusion deficit, excitotoxicity triggers a number of events that can further contribute to tissue death. Such events include peri-infarct depolarizations and spreading depolarizations (SDs) within the ischemic penumbra. SDs spread slowly through continuous gray matter at a typical velocity of 2-5mm/min. SDs exacerbate neuronal injury through prolonged ionic breakdown and SD-related hypoperfusion (spreading ischemia). Scalp EEG alone is not yet sufficient to reliably diagnose SDs. Hyperexcitability occurs in parallel, both in the acute and chronic phases of stroke. Stroke is a common cause of new-onset epileptic seizures after middle age and is the leading cause of symptomatic epilepsy in adults. The last part of this chapter is dedicated to noninvasive neurophysiologic techniques that can be used to promote stroke rehabilitation. These techniques mainly include repetitive transcranial magnetic stimulation and tDCS. These approaches are based on the concept of interhemispheric rivalry and aim at modulating the imbalance of cortical activities between both hemispheres resulting from stroke.
中风是第三大常见死因,也是后天神经功能障碍的主要原因。在缺血性中风期间,在局灶性灌注不足发作后很早的时候,兴奋性毒性就会引发一系列可能进一步导致组织死亡的事件。这些事件包括梗死周围去极化和缺血半暗带内的扩散性去极化(SDs)。SDs以2-5毫米/分钟的典型速度在连续的灰质中缓慢传播。SDs通过延长离子紊乱和与SD相关的低灌注(扩散性缺血)加剧神经元损伤。仅头皮脑电图不足以可靠地诊断SDs。在中风的急性期和慢性期,都会同时出现过度兴奋。中风是中年后新发癫痫发作的常见原因,也是成人症状性癫痫的主要原因。本章的最后一部分专门介绍可用于促进中风康复的非侵入性神经生理学技术。这些技术主要包括重复经颅磁刺激和经颅直流电刺激。这些方法基于半球间竞争的概念,旨在调节中风导致的两半球皮质活动失衡。