摘要
目的：对34例脑卒中患者进行半侧空间忽略（HSN）检测及SPECT局部脑血流（rCBF）显像，探讨脑卒中后HSN的发生、临床特征、影像学定位及神经解剖机制。方法：对临床确诊的34例单侧脑卒中患者进行HSN组合试验检测，包括直线平分试验、星星删除试验、图画复制试验，计算忽略评分。对忽略患者行SPECT rCBF显像，分析脑灌注降低的部位、范围、病灶数、病灶rCBF及降低百分比、病灶缺血体积及病灶总像素数，及其与忽略评分的相关性。结果：共30例患者有HSN表现。HSN可发生于左、右侧脑卒中患者，左、右侧脑卒中患者发生HSN、对侧忽略（CN）和同侧忽略（IN）均无差异。SPECT显像示HSN患者的损伤部位多见于额叶，其次是顶叶、枕叶、颞叶及基底节和丘脑。2个或2个以上部位的联合损伤更易出现忽略，最明显的部位是颞顶枕交界处。HSN患者的忽略评分与病灶范围、病灶数、病灶体积、像素数成正相关，r=0.543（P<0.01），0.462（P<0.05），0.429（P<0.05），0.437（P<0.05）；与病灶rCBF、病灶rCBF降低百分比相关性不明显（r=-0.175，0.266，P均＞0.05）。CN和IN患者在忽略评分、病灶范围、病灶数、病灶rCBF、rCBF降低百分比、病灶体积及病灶的总像素数方面均无明显差异。结论：HSN可发生于左、右侧脑卒中患者。HSN患者病灶范围越大、累及病灶数越多，病灶缺血体积越大，病灶像素数越大，忽略表现越严重。CN与IN在临床发生情况、忽略表现、SPECT显像方面均无明显差异。HSN可发生于多个大脑部位的损伤，多部位联合损伤忽略程度更明显。
Abstract
Objective: To explore the occurrence and clinical characters, location in image, and mechanism of hemispatial neglect(HSN), HSN test and SPECT rCBF imaging were performed on patients with stroke. Methods: Thirty-four dextromanual patients who were diagnosed as unilateral stroke clinically were recruited. A HSN test including line bisection test, star cancellation test and drawing test was performed on the subjects. The severity of neglect and rCBF, the range, number of the foci, the flow deficit size and the total numbers of pixels in the foci were measured on HSN test and SPECT rCBF imaging. Results: Thirty patients were diagnosed as HSN by the HSN test battery. Contralateral neglect(CN) and ipsilateral neglect(IN) happened on both the right and left hemispheres. On SPECT imagings, the patients with neglect had decreased rCBF in the frontal cortex mostly, parietal, occipital, temporal cortex secondly, and basal ganglia and thalamus the last. The patients who had two or more regions damaged showed neglect more easily and severe. The most significant region was temporal-parietal-occipital junction. The correlation coefficients between rCBF, the decreased percentage of rCBF and the severity of neglect were -0.175(P>0.05) and 0.266(P>0.05). The correlation coefficients between the range, number of foci, the flow deficit size, the total number of pixels of the foci and the severity of neglect were 0.543(P<0.01), 0.462(P<0.05), 0.429(P<0.05), 0.437(P<0.05), respectively. No difference reached significant between CN and IN on SPECT imaging. Conclusions: The severity of neglect correlates insignificantly with rCBF and the decrease percentage of rCBF, while it correlates positively with the range, number of foci, the flow deficit size and the total numbers of pixels of the foci. And CN and IN showed no difference on the occurrence, severity of neglect and the rCBF, the decreased percentage of rCBF, the range, and number of foci, the flow deficit size and the total numbers of pixels in the foci. We suggest that HSN is the damage of multiple sites, combine damage of which results in more severe neglect.
关键词
脑血管意外 /
体层摄影术 /
发射型计算机 /
单光子
Key words
Cerebrovascular accident /
Tomography /
emission-computed /
single-photon
尹雅芙;李雪娜;李亚明;顾 辉;韩春起;刘 浩.
脑卒中后半侧空间忽略的临床研究[J]. 中国临床医学影像杂志. 2008, 19(12): 837-841
YIN Ya-fu;LI Xue-na;LI Ya-ming;GU Hui;HAN Chun-qi;LIU Hao.
Preliminary clinical study in stroke patients with hemispatial neglect[J]. Journal of China Clinic Medical Imaging. 2008, 19(12): 837-841
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