Neurology病例:见于小脑卒中的前庭-眼反射缺损

2018-09-21 zyx整理 神经科病例撷英拾粹

69岁男性,表现为急性眩晕,恶心和呕吐。患者有左侧跳动性眼球震颤和异常的前庭眼反射,右侧头脉冲试验可见扫视矫正。

69岁男性,表现为急性眩晕,恶心和呕吐。患者有左侧跳动性眼球震颤和异常的前庭眼反射,右侧头脉冲试验可见扫视矫正。左眼追随运动受损,但没有其他小脑/神经系统体征(偏斜/听力丧失)。MRI提示急性卒中累及左侧小脑绒球小结区(图)。先前的研究表明,异常头脉冲试验(HIT)高度提示周围性起源,而不支持后颅窝卒中。本例说明这种临床试验特异性有限。HIT阳性患者中有9%罹患小脑卒中。


图:A:左侧小脑病变,DWI上可见高信号;B:对应ADC上为低信号;C-D:A和B中的病灶向尾部延伸[层厚5mm])

文献附带视频显示:左侧小脑绒球小结区卒中的眼球运动。左眼凝视追随异常;左侧自发性眼球震颤,伴旋转成分;右侧头脉冲试验可见扫视矫正,左侧正常;慢动作的扫视矫正扫视)

原始出处:Witsch J, Ferrer M, Navaratnam D. Teaching Video NeuroImages: Vestibulo-ocular reflex defect in cerebellar stroke. Neurology. 2018 Aug 28;91(9):e888-e889.

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    2018-10-29 yinhl1978
  2. [GetPortalCommentsPageByObjectIdResponse(id=2000588, encodeId=2d25200058819, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Mon Oct 29 11:02:00 CST 2018, time=2018-10-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=345976, encodeId=c5ec3459e633, content=学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRkia1DP5MpwEgtXo1XhXA11xD6MWKxunAZFXKSNic0fWHUQx83oNHPlRMxxIctM83QKeCLkJpMibibiaC/0, createdBy=7e581734408, createdName=深海的鱼, createdTime=Fri Sep 21 08:19:05 CST 2018, time=2018-09-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=345947, encodeId=3a7634594e0c, content=嗯嗯,学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/07/16/3b24606172648eea459125cb74754afe.jpg, createdBy=6c022216608, createdName=liumin1987, createdTime=Fri Sep 21 07:56:51 CST 2018, time=2018-09-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026158, encodeId=0f5f10261589e, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Fri Sep 21 03:02:00 CST 2018, time=2018-09-21, status=1, ipAttribution=)]
    2018-09-21 深海的鱼

    学习学习学习

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=2000588, encodeId=2d25200058819, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Mon Oct 29 11:02:00 CST 2018, time=2018-10-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=345976, encodeId=c5ec3459e633, content=学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRkia1DP5MpwEgtXo1XhXA11xD6MWKxunAZFXKSNic0fWHUQx83oNHPlRMxxIctM83QKeCLkJpMibibiaC/0, createdBy=7e581734408, createdName=深海的鱼, createdTime=Fri Sep 21 08:19:05 CST 2018, time=2018-09-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=345947, encodeId=3a7634594e0c, content=嗯嗯,学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/07/16/3b24606172648eea459125cb74754afe.jpg, createdBy=6c022216608, createdName=liumin1987, createdTime=Fri Sep 21 07:56:51 CST 2018, time=2018-09-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026158, encodeId=0f5f10261589e, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Fri Sep 21 03:02:00 CST 2018, time=2018-09-21, status=1, ipAttribution=)]
    2018-09-21 liumin1987

    嗯嗯,学习了。

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=2000588, encodeId=2d25200058819, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Mon Oct 29 11:02:00 CST 2018, time=2018-10-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=345976, encodeId=c5ec3459e633, content=学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRkia1DP5MpwEgtXo1XhXA11xD6MWKxunAZFXKSNic0fWHUQx83oNHPlRMxxIctM83QKeCLkJpMibibiaC/0, createdBy=7e581734408, createdName=深海的鱼, createdTime=Fri Sep 21 08:19:05 CST 2018, time=2018-09-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=345947, encodeId=3a7634594e0c, content=嗯嗯,学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/07/16/3b24606172648eea459125cb74754afe.jpg, createdBy=6c022216608, createdName=liumin1987, createdTime=Fri Sep 21 07:56:51 CST 2018, time=2018-09-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026158, encodeId=0f5f10261589e, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Fri Sep 21 03:02:00 CST 2018, time=2018-09-21, status=1, ipAttribution=)]
    2018-09-21 健健

    卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!

    0

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