老年患者肢体抖动型短暂性脑缺血发作21例临床分析 Case Analysis of Limb-shaking Transient Ischemic Attack in 21 Elderly Patients

Abstract

目的 探讨总结老年患者肢体抖动型短暂性脑缺血发作（limb-shaking transient ischemic attack，LSTIA） 的临床特点及发病机制。 方法 采用回顾性分析，收集2013年1月-2017年6月在芜湖市第一人民医院神经内科住院确诊的21 例LS-TIA患者的临床资料及治疗方案。 结果 21例患者均表现为一侧肢体短暂性、发作性不能控制的不自主抖动，所有患者均存在抖 动肢体对侧的颅内和（或）颅外大动脉重度狭窄或闭塞（100%）。患者住院期间均行磁共振成像 （magnetic resonance imaging，MRI）及磁共振血管成像（magnetic resonance angiography，MRA）检查及常 规检查，并接受抗血小板、强化他汀治疗，适当控制血压，积极治疗原发病，临床症状均明显缓解， 随访期间均未再出现TI A发作，无脑血管事件发生。 结论 一侧肢体抖动时应警惕LS-TI A可能。LS-TI A患者多存在对侧的颅内外动脉重度狭窄或闭塞，应 对此类患者完善相关血管检查，进行卒中二级预防。 Abstract: Objective To summarize the clinical characteristics and pathogenesis of limb-shaking transient ischemic attack (LS-TIA) in elderly patients, and to provide reference for clinicians. Methods The general clinical data and treatment regimen of 21 LS-TIA elderly patients in Wuhu hospital from January 2013 to June 2017 were collected, and a retrospective analysis was performed to summarize the clinical characteristics of LS-TIA. Results All of the 21 elderly patients presented with unilateral limb transient and uncontrollable involuntary shaking. All patients had contralateral intracranial and/or extracranial arteries severe stenosis or occlusion diagnosed by MRI+DWI+MRA examination. All patients were given antiplatelet and intensive statin therapy, proper control of blood pressure and treatment of primary diseases. After the treatment, clinical symptoms of all patients were alleviated, and no TIA and other cerebrovascular events occurred during the follow-up. Conclusions LS-TIA should be considered when occurring unilateral limb paroxysmal shaking. In general, LS-TIA patients have contralateral intracranial and/or external arteries stenosis or occlusion, and these patients should be given aggressive stroke secondary prevention.

Keywords

• 短暂性脑缺血发作
• 肢体抖动
• 大动脉狭窄
• transient ischemic attack
• limb shake
• large artery stenosis