Visocchi M, Cioni B, Pentimalli L, Meglio M
Istituto di Neurochirurgia, Università Cattolica S. Cuore, Roma, Italia.
Stereotact Funct Neurosurg. 1994;62(1-4):103-7. doi: 10.1159/000098604.
A 64-year-old man had an ischemic stroke in the left parietotemporal cortical-subcortical areas. He developed a severe right spastic hemiparesis and dysphasia. An angiographic study showed left internal carotid artery occlusion and right internal carotid artery stenosis. A right internal endoarteriectomy was performed without any clinical improvement. After 1 year the patient was a candidate for cervical spinal cord stimulation (SCS) for the treatment of his spastic hemiparesis. An epidural electrode (Medtronic Sigma 3483) was positioned at the cervical level, mediodorsal to the cord. Clinical and neurophysiological studies (surface polyelectromyography, PEMG, for evaluation of brain motor control) were performed before and after 7 days of SCS (0.2 ms, 80 c/s, intensity for paresthesiae, continuous mode). A transcranial Doppler (TCD) study of both middle cerebral arteries (MCA) at rest and during SCS was performed on two occasions. SCS was followed by improvement of voluntary movement, decrease of spasticity and better endurance. The clinical findings were confirmed by the PEMG recordings. TCD examination showed an increase of flow velocities on both the right MCA (+43%) and the left MCA (+130%) during SCS. Such a TCD pattern, suggesting an increase of cerebral blood flow (CBF) during SCS, was reproducible. This case confirms efficacy of SCS in the treatment of ischemic hemiparesis and the increase of CBF following cervical SCS in man. The marked increase of CBF, particularly evident on the ischemic side, may play a role in mediating the improvement of motor control in our patient together with a possible arousal of the so-called 'sleeping neurons' of the penumbra zone.
一名64岁男性在左侧顶颞叶皮质下区域发生缺血性中风。他出现了严重的右侧痉挛性偏瘫和失语症。血管造影研究显示左侧颈内动脉闭塞和右侧颈内动脉狭窄。进行了右侧颈内动脉内膜切除术，但临床症状未得到改善。1年后，该患者成为接受颈脊髓刺激（SCS）治疗痉挛性偏瘫的候选者。将一个硬膜外电极（美敦力Sigma 3483）置于颈部脊髓的中背侧。在SCS治疗7天前后（0.2毫秒，80次/秒，产生感觉异常的强度，连续模式）进行了临床和神经生理学研究（表面多电极肌电图，PEMG，用于评估脑运动控制）。两次对双侧大脑中动脉（MCA）在静息状态和SCS期间进行经颅多普勒（TCD）研究。SCS治疗后，患者的自主运动得到改善，痉挛减轻，耐力增强。PEMG记录证实了临床发现。TCD检查显示，在SCS期间，右侧MCA的血流速度增加了43%，左侧MCA的血流速度增加了130%。这种TCD模式表明SCS期间脑血流量（CBF）增加，且具有可重复性。该病例证实了SCS治疗缺血性偏瘫的有效性以及颈段SCS后人体CBF的增加。CBF的显著增加，尤其是在缺血侧，可能在介导患者运动控制改善方面发挥作用，同时可能唤醒半暗带所谓的“休眠神经元”。
