脑卒中后Holmes震颤发生率及其预后

doi:10.3969/j.issn.1006-9771.2022.01.008

Abstract

Abstract:

Objective To investigate the incidence of Holmes tremor (HT) after stroke and its outcome after medication and rehabilitation. Methods Patients diagnosed as HT after stroke in the ward of neurorehabilitation department from October, 2019 to September, 2021 were reviewed the clinical features, imaging manifestations, drug treatment plan, rehabilitation evaluation scales scores, rehabilitation plan and outcome. Results There were five inpatients with HT (0.7%, 5/715), and all were hemorrhagic stroke, accounting for 1.7% of hemorrhagic stroke. The lesions were located in the midbrain and pons in three cases, cerebellum in one case and thalamus in one case. The tremor appeared 1.5 to seven months after stroke, limited on head and limbs, with other neurological dysfunction. After the comprehensive treatment of drugs and rehabilitation, tremor improved in four cases, and ineffective in one case. The motor and balance function improved less, and the activities of daily living improved somehow. Conclusion The incidence of Holmes tremor is low in stroke patients. The tremor might respond to the treatment, but motor function would not.

Key words: stroke, Helmos tremor, morbidity, outcome, rehabilitation

CLC Number:

R743.3

GAO Fei,LIU Lixu,CHEN Yudong,YANG Yuqi,LI Hanzhi,HU Xueyan,SHAN Lei,WU Xiaoli,YE Changqing. Morbidity and outcome of post-stroke Holmes tremor[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(1): 50-54.

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References 20

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项目	病例1	病例2	病例3	病例4	病例5
性别	男	男	男	男	男
年龄/岁	48	62	33	52	63
病因	高血压性脑出血	高血压性脑出血	海绵状血管瘤伴出血	高血压性脑出血	高血压性脑出血
病灶部位	左侧中脑脑桥	小脑	中脑	脑桥	左侧丘脑
震颤延迟时间/月	7	1.5	2	3.5	5
震颤性质	左上肢静止性、意向性	左上肢静止性、意向性	四肢意向性、姿势性	左上肢静止性、意向性	左上肢静止性、意向性
头部震颤	有	有	有	有	有
Brunnstrom分期 (上肢-手-下肢)	右Ⅴ-Ⅴ-Ⅴ	双侧Ⅳ-Ⅳ-Ⅳ	双侧Ⅴ-Ⅴ-Ⅴ	左Ⅲ-Ⅲ-Ⅱ	右Ⅱ-Ⅱ-Ⅲ
失语	无	有	无	无	有
构音障碍	有	无	有	有	无
眼肌麻痹及眼震	有	无	有	有	无
其他颅神经	无	无	无	右面神经麻痹	无
吞咽障碍	有	有	无	有	无
感觉异常	右侧消失	不配合	右侧减退	左侧减退	不能配合
并发HOD	未做MRI	无	无	有	无
治疗药物	氟哌啶醇+多巴丝肼片+氯硝西泮+左乙拉西坦+吡贝地尔缓释片+苯海索	苯海索+氯硝西泮+氟哌啶醇	氯硝西泮	多巴丝肼片+左乙拉西坦+氯硝西泮	苯海索+氯硝西泮
康复方案	针灸+悬吊+PT+OT	针灸+PT+OT+语言+吞咽	PT+OT+平衡+悬吊+天轨	PT+OT+针灸+吞咽	PT
结局	震颤减轻	震颤消失	震颤减轻	震颤减轻	无效

时间	n	FMA运动	FMA平衡	BI
治疗前	5	42.8±23.4	3.8±3.8	25.0±15.0
治疗后	5	45.8±24.7	4.6±3.7	30.0±13.7
t值		1.50	1.37	3.16
P值		0.21	0.24	0.03

Morbidity and outcome of post-stroke Holmes tremor

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