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探讨与脑卒中后患者出现偏侧舞蹈症/偏侧投掷症相关的因素。

Investigation of the factors associated with hemichorea/hemiballismus in post-stroke patients.

机构信息

Neurology Clinic, Diskapi Yildirim Beyazit Training and Research Hospital, Şehit Ömer Halisdemir Street. No: 20 Altındag, 06110, Ankara, Turkey.

出版信息

J Neural Transm (Vienna). 2023 May;130(5):679-685. doi: 10.1007/s00702-023-02628-3. Epub 2023 Apr 3.

Abstract

Classical knowledge highlights the role of lesions of the subthalamic nuclei (STN) in the pathophysiology of hemichorea/hemiballismus (HH). However, the published reports indicate various other lesion regions in the majority of post-stroke cases with HH. Ergo, we aimed to investigate the significance of the lesion site and clinical features for developing HH in post-stroke patients. Overall, we retrospectively scanned all the patients with stroke who were hospitalized between 01/06/2022 and 31/07/2022 in our neurology clinic. The data regarding the demographic features, comorbidities, stroke etiologies, and laboratory findings, including serum glucose and HBA1C were retrospectively recruited using the electronic-based medical record system. The cranial magnetic resonance imaging (MRI) and computed tomography images have been systematically evaluated for the presence of lesions in localizations that are previously associated with HH. We conducted comparative analyses between patients with and without HH to reveal the discrepancies between groups. The logistic regression analyses were also performed to reveal the predictive values of some features. Overall, the data of 124 post-stroke patients were analyzed. The mean age was 67.9 ± 12.4 years (F/M = 57/67). Six patients were determined to develop HH. The comparative analyses between patients with and without HH revealed that the mean age tended to be higher in the HH group (p = 0.08) and caudate nucleus involvement was more common in the HH group (p = 0.005). Besides cortical involvement was absent in all subjects developing HH. The logistic regression model revealed the presence of a caudate lesion and advanced age as factors associated with HH. We found that the caudate lesion was a crucial determinant of the occurrence of HH in post-stroke patients. With the significance of the other factors of increased age and cortical sparring, we observed differences in the HH group may be investigated also in future-related studies on larger groups.

摘要

经典知识强调了苍白球(GPi)和丘脑底核(STN)病变在亨廷顿舞蹈病(HD)发病机制中的作用。然而,已发表的报告表明,在大多数中风后伴有 HH 的病例中,存在各种其他病变区域。因此,我们旨在研究病变部位和临床特征在中风后患者发生 HH 中的意义。总的来说,我们回顾性地扫描了我们神经病学诊所 2022 年 6 月 1 日至 7 月 31 日期间住院的所有中风患者。使用电子病历系统回顾性收集了人口统计学特征、合并症、中风病因和实验室检查结果(包括血糖和 HBA1C)的数据。对颅磁共振成像(MRI)和计算机断层扫描图像进行了系统评估,以确定与 HH 相关的局灶性病变。我们对有和没有 HH 的患者进行了比较分析,以揭示组间差异。还进行了逻辑回归分析,以揭示一些特征的预测值。总的来说,分析了 124 例中风后患者的数据。平均年龄为 67.9±12.4 岁(F/M=57/67)。有 6 名患者被确定为发生 HH。有和没有 HH 的患者之间的比较分析表明,HH 组的平均年龄较高(p=0.08),并且 HH 组壳核受累更常见(p=0.005)。此外,所有发生 HH 的患者均无皮质受累。逻辑回归模型显示壳核病变和年龄较大是与 HH 相关的因素。我们发现壳核病变是中风后患者发生 HH 的关键决定因素。考虑到其他因素(年龄较大和皮质无损伤)的重要性,我们观察到 HH 组之间的差异可能也可以在未来对更大的患者群体进行的相关研究中进行研究。

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