1例32歲女性右側(cè)腦出血患者發(fā)病后8和11個月皮質(zhì)脊髓束彌散張量成像
（黃色和紅色分別為左側(cè)和右側(cè)大腦半球皮質(zhì)脊髓束）
步態(tài)異常是腦卒中最嚴(yán)重的后遺癥之一,。如何使腦卒中患者恢復(fù)正常的步態(tài)是神經(jīng)康復(fù)領(lǐng)域的重要研究課題之一。事實上,，腦卒中患者對步態(tài)恢復(fù)程度的要求不如手功能那么高,，因為髖和膝關(guān)節(jié)運動功能恢復(fù)時，其即可在一定程度上抵抗重力作用行走,?？傮w來說，大多數(shù)腦卒中患者運動功能恢復(fù)發(fā)生在發(fā)病后3-6個月,，行走功能恢復(fù)一般發(fā)生在發(fā)病后3個月,。因此臨床醫(yī)師要尤其關(guān)注那些腦卒中發(fā)病后3-6個月，步態(tài)異常仍沒什么改善的患者,。韓國嶺南大學(xué)醫(yī)學(xué)院Sung Ho Jang領(lǐng)導(dǎo)的團隊報道了1例腦出血后8-11個月步態(tài)延遲恢復(fù)的病例,。該患者為32歲女性,，動靜脈畸形破裂致右側(cè)腦出血后行開顱和引流,。大腦MRI顯示，右側(cè)頂額葉皮質(zhì)損害,。發(fā)病后8個月,，彌散張量成像顯示右側(cè)皮質(zhì)脊髓束嚴(yán)重?fù)p傷。同時,，雖然患者從發(fā)病后2個月開始行康復(fù)干預(yù),，但仍不能站立和行走。左腿和右踝的嚴(yán)重痙攣是導(dǎo)致這一結(jié)果的原因,。經(jīng)過抗痙攣藥物和康復(fù)干預(yù)后,，痙攣得以控制，患者能夠站立,。另外,，患者感覺運動功能、空間視覺功能,、認(rèn)知功能的改善也有助于步態(tài)的恢復(fù),。最終發(fā)病后11個月，患者能夠在平坦的地面上行走。提示臨床醫(yī)師應(yīng)該找到腦卒中后3-6個月仍不能行走的步態(tài)延遲恢復(fù)的原因,，才能更好的制定有針對性的康復(fù)措施,。相關(guān)文章發(fā)表于2013年6月第16期《中國神經(jīng)再生研究（英文版）》雜志上。（生物谷 Bioon.com）
生物谷推薦的英文摘要
Neural Regeneration Research DOI: 10.3969/j.issn.1673-5374.2013.16.008
Delayed gait recovery in a stroke patient
Jeong Pyo Seo, Mi Young Lee, Yong Hyun Kwon, Sung Ho Jang
We report on a stroke patient who showed delayed gait recovery between 8 and 11 months after the onset of intracerebral hemorrhage. This 32-year-old female patient underwent craniotomy and drainage for right intracerebral hemorrhage due to rupture of an arteriovenous malformation. Brain MR images revealed a large leukomalactic lesion in the right fronto-parietal cortex. Diffusion tensor tractography at 8 months after onset revealed that the right corticospinal tract was severely injured. At this time, the patient could not stand or walk despite undergoing rehabilitation from 2 months after onset. It was believed that severe spasticity of the left leg and right ankle was largely responsible, and thus, antispastic drugs, antispastic procedures (alcohol neurolysis of the motor branch of the tibial nerve and an intramuscular alcohol wash of both tibialis posterior muscles) and physical therapy were tried to control the spasticity. These measures relieved the severe spasticity, with the result that the patient was able to stand at 3 months. In addition, the improvements in sensorimotor function, visuospatial function, and cognition also seemed to contribute to gait recovery. As a result, she gained the ability to walk independently on even floor with a left ankle foot orthosis at 11 months after onset. This case illustrates that clinicians should attempt to find the cause of gait inability and to initiate intensive rehabilitation in stroke patients who cannot walk at 3–6 months after onset.
