Firlik A D, Firlik K S, Yonas H
Department of Neurological Surgery, University of Pittsburgh Medical Center, Presbyterian University Hospital, Pennsylvania, USA.
Neurosurgery. 1996 Sep;39(3):607-11. doi: 10.1097/00006123-199609000-00037.
Although recurrent limb shaking has been observed in patients with carotid occlusion, its cause, method of diagnosis, and definitive treatment have yet to be fully elucidated. This report examines the cerebrovascular physiology of a patient with recurrent limb shaking by means of xenon-enhanced computed tomographic (XeCT) scanning. By measuring cerebral blood flow (CBF) and cerebrovascular reserve capacity, we were able to confirm both the clinical diagnosis and the response to treatment on physiological grounds.
The patient is a 49-year-old man who presented with frequent brief attacks of left arm and leg shaking that occurred at standing or coughing. After cervical radiation therapy for a laryngeal carcinoma, he was found to have bilateral carotid occlusion with minimal collateral development. XeCT scans revealed borderline ischemic perfusion and lack of cerebrovascular reserve in response to an acetazolamide vasodilatory challenge.
The patient underwent a right superficial temporal artery to middle cerebral artery bypass to augment cerebral perfusion.
After the procedure, the patient's limb shaking attacks ceased. The postoperative XeCT scan showed improved CBF and a return of cerebrovascular reserve capacity. Recurrent limb shaking is a manifestation of decreased CBF. Quantitative XeCT CBF studies coupled with vasodilatory challenge is an important way to assess patients with cerebrovascular disorders and thus identify individuals who will benefit from cerebral revascularization.
尽管在颈动脉闭塞患者中观察到反复肢体抖动，但其病因、诊断方法及确切治疗方法尚未完全阐明。本报告通过氙增强计算机断层扫描（XeCT）对一名反复肢体抖动患者的脑血管生理学进行了研究。通过测量脑血流量（CBF）和脑血管储备能力，我们能够从生理学角度证实临床诊断及治疗反应。
患者为一名49岁男性，站立或咳嗽时出现频繁的左臂和腿部短暂抖动发作。在因喉癌接受颈部放射治疗后，发现其双侧颈动脉闭塞，侧支循环发育极少。XeCT扫描显示在乙酰唑胺血管舒张激发试验中存在临界性缺血灌注且缺乏脑血管储备。
患者接受了右侧颞浅动脉至大脑中动脉搭桥手术以增加脑灌注。
手术后，患者的肢体抖动发作停止。术后XeCT扫描显示CBF改善且脑血管储备能力恢复。反复肢体抖动是CBF降低的一种表现。定量XeCT CBF研究结合血管舒张激发试验是评估脑血管疾病患者并从而确定将从脑血运重建中获益个体的重要方法。
