Clinical Features and Related Factors of Poststroke Pathological Laughing and Crying: A Case-Control Study
Clinical Features and Related Factors of Poststroke Pathological Laughing and Crying: A Case-Control Study
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中风后病理性笑哭的临床特征及相关因素：病例对照研究
DOI：
10.1016/j.jstrokecerebrovasdis.2015.11.003
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发表时间：
2016
影响因子：
2.5
通讯作者：
Jin Lingjing
中科院分区：
文献类型：
--
作者：
Wang Geying;Teng Fei;Chen Yuhui;Liu Yuanhua;Li Yancheng;Cai Li;Zhang Xu;Nie Zhiyu;Jin Lingjing
目的：本研究的目的是分析卒中后病理性笑哭（PSPLC）的临床特征和相关因素，并区分有和无假性球征的PSPLC患者。方法：我们进行了一项病例对照研究，其中 56 名 PSPLC 患者与 56 名对照中风患者按年龄和性别进行匹配。使用病理性笑和哭量表来识别 PSPLC 患者。分析了 PSPLC 爆发的特征、假性延髓体征和自主神经症状的存在、病变部位和不同的临床数据。轻度认知障碍（MCI）由蒙特利尔认知评估进行评估。通过比较患者的病前状态来评估中风后愤怒倾向（PSAP）。结果：PSPLC 组中出现 MCI、PSAP 和假性延髓体征的患者明显多于对照组。大多数 PSPLC 患者表现为双侧多发性病变，其中脑桥（尤其是双侧基底正中旁区和基底被盖区）是最重要的病变部位。 Logistic回归分析显示，脑桥病变、MCI、PSAP与PSPLC独立相关；然而，假性球征的存在与否无关。出现假性延髓征的 PSPLC 患者在过去 2 年内卒中复发次数较多，神经功能缺损更严重，PSPLC 的严重程度也更高。此外，假性延髓征组中更多的患者表现出伴随的自主神经症状。结论：PSPLC、MCI 和 PSAP 可能是更普遍疾病的表现，其中脑桥病变起着重要作用。有假球征的 PSPLC 患者与无假球征的患者表现出不同的特征。
Objectives: The purpose of this study was to analyze clinical features and related factors of poststroke pathological laughing and crying (PSPLC) and to differentiate PSPLC patients with and without pseudobulbar signs. Methods: We performed a case–control study in which 56 patients with PSPLC were matched to 56 control stroke patients by age and gender. The pathological laughing and crying scale was used to identify patients with PSPLC. Characteristics of PSPLC outbursts, presence of pseudobulbar signs and autonomic symptoms, lesion locations, and different clinical data were analyzed. Mild cognitive impairment (MCI) was evaluated by the Montreal Cognitive Assessment. Poststroke anger proneness (PSAP) was evaluated by comparison of the patients’ premorbid states. Results: Significantly more patients in the PSPLC group showed MCI, PSAP, and pseudobulbar signs than those in the control group. Most patients with PSPLC showed bilateral multiple lesions and the pons (especially the bilateral paramedian basal and basal–tegmental areas) stood out as the most important lesion location. Logistic regression analysis showed that pontine lesion, MCI, and PSAP were independently.related to PSPLC; however, the presence of pseudobulbar signs was not related. PSPLC patients with pseudobulbar signs showed more recurrent strokes.in the previous 2 years, more severe neurological deficits, as well as higher severity of PSPLC. In addition, more patients in the group with pseudobulbar signs showed concomitant autonomic symptoms. Conclusions: PSPLC, MCI, and PSAP could be manifestations of a more general disorder, in which pontine lesion plays an important role. PSPLC patients with pseudobulbar signs and those without show different features.