Successful Intravenous Thrombolysis in a Stroke Patient With Hemiballism
Successful Intravenous Thrombolysis in a Stroke Patient With Hemiballism
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中风偏瘫患者成功静脉溶栓
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发表时间：
2011
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通讯作者：
L. Beslać
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作者：
J. Zidverc;D. Jovanović;I. Marjanović;A. Radojicic;L. Beslać
偏侧球症（HB）是一种相对罕见的多动障碍，通常由急性脑卒中引起。这类患者通常接受对症治疗，效果有限。我们报告的情况下，急性中风患者HB谁是成功地治疗静脉重组组织纤溶酶原激活剂（rtPA）。病例报告一位有高血压和缺血性冠心病病史的67岁男性，在左臂和左腿突然出现不自主的粗糙投掷运动后85分钟出现在急诊室。神经系统检查显示口下颌运动障碍;左眼睑痉挛;头颈部运动障碍;构音障碍;以及涉及左臂和左腿的有力、急动、不规则、投掷、大幅度不自主运动。最初的脑电脑断层扫描显示，只有轻微的融合脑室周围低密度在附近的前角。对于构音障碍，计算的国立卫生研究院卒中量表评分为1。然而，HB的突然发作提示急性卒中，我们决定用静脉注射rtPA治疗患者。在症状发作后200分钟开始rtPA溶栓治疗，并且在患者的动脉血压升高消退后开始。治疗后12小时进行的随访检查仅显示轻度构音障碍;左臂轻度共济失调和共济失调步态。尽管液体衰减反转恢复磁共振成像序列显示右壳核和左小脑半球附近存在高信号强度病变，但延迟脑部计算机断层扫描并未表明近期缺血。1个月后，随访检查发现只有轻度构音障碍和轻度共济失调的左arm. ConclusionsAcute中风患者低国立卫生研究院中风量表评分，包括HB患者，应被视为候选人溶栓治疗。
IntroductionHemiballism (HB) is a relatively rare hyperkinetic disorder commonly caused by an acute stroke. Such patients usually receive symptomatic therapy with limited effect. We report the case of an acute stroke patient with HB who was successfully treated with intravenous recombinant tissue plasminogen activator (rtPA). Case ReportA 67-year-old man with a history of hypertension and ischemic coronary heart disease presented in the emergency room 85 minutes after sudden onset of involuntary coarse flinging movements of the left arm and leg. Neurological investigation revealed oromandibular dyskinesia; left blepharospasm; dyskinetic movements of the head and neck; dysarthria; and forceful, jerky, irregular, flinging, large-amplitude involuntary movements involving his left arm and left leg. Initial brain computed tomography showed only mild confluent periventricular hypodensities in the vicinity of the frontal horns. The calculated National Institutes of Health Stroke Scale score was 1, for dysarthria. The sudden onset of HB, however, suggested an acute stroke and we decided to treat the patient with intravenous rtPA. Thrombolytic therapy with rtPA began 200 minutes after symptom onset, and after the patient's increased arterial blood pressure was resolved. Follow-up examination performed 12 hours after therapy revealed only mild dysarthria; mild ataxia of the left arm, and ataxic gait. Delayed brain computed tomography did not indicate recent ischemia, although a fluid attenuated inversion recovery magnetic resonance imaging sequence revealed high signal intensity lesions in the vicinity of the right putamen and left cerebellar hemisphere. After 1 month, a follow-up examination revealed only mild dysarthria and mild ataxia of the left arm. ConclusionsAcute stroke patients with low National Institutes of Health Stroke Scale score, including patients with HB, should be considered as candidates for thrombolytic treatment.