Sakakibara R, Hattori T, Yasuda K, Yamanishi T
Department of Neurology, Chiba University School of Medicine, Japan.
J Neurol Sci. 1996 Sep 15;141(1-2):105-10. doi: 10.1016/0022-510x(96)00079-2.
Micturitional histories were taken from 39 patients with acute brainstem stroke. Within 3 months from onset, 49% had irritative as well as obstructive urinary symptoms, the most common being voiding difficulty and nocturnal urinary frequency in 28%, followed by urinary retention in 21%. Urodynamic studies of 11 symptomatic patients revealed detrusor hyperreflexia in 73%, low compliance bladder in 9%, atonic cystometrogram in 27%, detrusor-sphincter dyssynergia in 45% and uninhibited sphincter relaxation in 27%. Three asymptomatic patients had normal urodynamic findings. Brain magnetic resonance images of the lesions of the symptomatic patients were concentrated in the dorsolateral pons including pontine reticular nucleus and the reticular formation adjacent to the medial parabrachial nucleus and the locus coeruleus. These regions seem to be mainly responsible for supranuclear types of pelvic and pudendal nerve dysfunction in our patients with brainstem stroke, corresponding to the pontine urinary storage and micturation center reported in animal studies.
我们收集了39例急性脑干卒中患者的排尿史。发病3个月内，49%的患者出现刺激性和梗阻性排尿症状，最常见的是排尿困难和夜尿症，各占28%，其次是尿潴留，占21%。对11例有症状的患者进行尿动力学研究，结果显示73%的患者存在逼尿肌反射亢进，9%的患者膀胱顺应性降低，27%的患者膀胱测压图无张力，45%的患者存在逼尿肌-括约肌协同失调，27%的患者存在括约肌松弛不受抑制。3例无症状患者的尿动力学检查结果正常。有症状患者病变的脑磁共振成像集中在脑桥背外侧，包括脑桥网状核以及与内侧臂旁核和蓝斑相邻的网状结构。在我们的脑干卒中患者中，这些区域似乎主要负责盆腔和阴部神经功能障碍的核上型，这与动物研究中报道的脑桥储尿和排尿中枢相对应。
