Hemichorea-Hemiballism in a patient with temporal-parietal lobe infarction appearing after reperfusion by recombinant tissue plasminogen activator
Hemichorea-Hemiballism in a patient with temporal-parietal lobe infarction appearing after reperfusion by recombinant tissue plasminogen activator
复制标题
重组组织纤溶酶原激活剂再灌注后出现颞顶叶梗死患者的偏侧舞蹈症
DOI：
10.1002/mdc3.12198
复制
发表时间：
2015
期刊：
影响因子：
--
通讯作者：
Ugawa Y
中科院分区：
文献类型：
--
作者：
Murakami T;Wada T;Sasaki I;Yoshida K;Segawa M;Kadowaki S;Yoshihara A;Kobayashi S;Hoshi A;Sugiura Y;Ugawa Y
偏侧舞蹈症-偏侧投掷症（HC-HB）与脑卒中病变典型相关。1-3一项大型临床研究报告称，基底神经节中的一些其他病变，如尾状核和壳核，也可能导致HC-HB，4这很少是皮质梗死的结果。我们观察到一例颞顶叶脑梗死患者在静脉注射重组组织型纤溶酶原激活剂（rtPA）后出现短暂HC-HB，该患者无基底节（包括小脑）任何病变，72岁右利手女性，无糖尿病史，也无多巴胺能药物使用史，因突发左侧轻偏瘫入院。神经系统检查发现空间定向障碍，共轭眼偏向右侧，构音障碍。她有左侧轻偏瘫和感觉障碍的所有形式。深腱反射在患肢被夸大。足底反应为双侧屈肌。入院时美国国立卫生研究院卒中量表（NIHSS）为19分。除脑利钠肽（717 pg/mL）和D-二聚体（10.3 μg/mL）升高外，血液样本检查正常。甲状腺功能正常，排除高血糖。脑MRI显示右侧颞顶叶急性脑梗死，大脑中动脉（MCA;图1A，B）灌注。心电图显示房颤。患者被诊断为心源性栓塞性梗死，在症状发作后3小时内给予rtPA。9小时后，轻偏瘫明显改善，NIHSS评分为8分（下降11分）。在运动改善之后，左手开始表现出舞蹈动作，例如刻板的旋前和旋后，在一天的时间内进展为弹道臂运动。最终，左下肢也受累，证实了HC-HB综合征（视频1）。后续脑部MRI
Hemichorea-hemiballism (HC-HB) is classically associated with stroke lesions in the STN. 1–3 A large clinical study reported that some other lesions in the basal ganglia, such as in the caudate and putamen, may also cause HC-HB, 4 which is seldom the result of a cortical infarction. We observed transient HC-HB in a patient with a cerebral infarction in the temporal-parietal lobe without any lesions in the basal ganglia including the STN after intravenous recombinant tissue plasminogen activator (rtPA) administration.A 72-year-old right-handed female, who had neither a history of diabetes mellitus nor dopaminergic medication use, was admitted to our hospital because of sudden-onset leftsided hemiparesis. Neurological examination revealed spatial disorientation, conjugate eye deviation to the right, and dysarthria. She had left-sided hemiparesis and sensory disturbance of all modalities. Deep tendon reflexes were exaggerated in the affected limbs. The plantar response was bilaterally flexor. National Institutes of Health Stroke Scale (NIHSS) was 19 points on admission. Blood sample tests were normal except for elevations of brain natriuretic peptide (717 pg/mL) and D-dimer (10.3 μg/mL). Thyroid function was normal, and hyperglycemia was ruled out. Brain MRIs showed acute cerebral infarction in the right temporal-parietal lobe perfused by the middle cerebral artery (MCA; Fig. 1A, B). Electrocardiogram showed atrial fibrillation. The patient was diagnosed as having cardioembolic infarction, and rtPA was administered within 3 hours after onset of symptoms. Nine hours later, her hemiparesis was improved significantly, which was reflected in the NIHSS score of 8 points (11-point decrease). Subsequent to motor improvement, the left hand started to show choreic movements, such as stereotypic pronation and supination, which progressed into ballistic arm movements in a day’s time. Eventually, the left-lower extremity was also involved, confirming HC-HB syndrome (Video 1). Subsequent brain MRIs