脑血管疾病后Holmes震颤的临床、影像和电生理特点

doi:10.3969/j.issn.1673-5765.2020.04.013

摘要/Abstract

摘要：

目的总结脑血管疾病后Holmes震颤的临床、影像和电生理特点。方法回顾性分析2015年8月-2019年8月就诊于首都医科大学附属北京天坛医院的4例脑血管疾病所致Holmes震颤患者，对其临床、影像及电生理资料进行分析总结。结果 4例患者中2例由高血压性脑出血引起，另外2例分别由脑动静脉畸形和脑海绵状血管瘤破裂出血引起。Holmes震颤出现于原发病后1～24个月，表现为病灶对侧肢体震颤，以上肢多见。头颅MRI 检查显示2例患者病灶仅累及丘脑，2例同时累及丘脑和中脑。震颤分析显示静止、姿势、意向及持物 1000 g几种状态下震颤的峰频率均在2.6～3.8 Hz，意向状态震颤半宽功率高于静止状态。主动肌与拮抗肌在静息时以同步收缩为主，姿势、意向和持物时以交替收缩为主。3例接受普拉克索治疗均有不同程度缓解。结论 Holmes震颤多由累及中脑、丘脑部位脑血管疾病引起，表现为2～4 Hz低频震颤，意向状态震颤明显，部分患者多巴胺受体激动剂治疗有效。

文章导读： Holmes震颤多由中脑及丘脑区脑血管疾病引起，表现为2～4 Hz低频震颤，意向时震颤明显，部分患者多巴胺受体激动剂治疗有效。

关键词: Holmes震颤; 磁共振成像; 峰频率; 半宽功率

Abstract:

Objective To summarize the clinical, imaging and electrophysiological characteristics of Holmes tremor induced by cerebrovascular disease. Methods Four patients with Holmes tremor at Department of Neurology of Beijing Tian Tan Hospital and from August 2015 to August 2019 were retrospectively analyzed, to summarize their clinical, imaging and electrophysiological features. Results Two of four patients were caused by hypertensive intracerebral hemorrhage and the other two were caused by hemorrhage of arteriovenous malformation and cerebral cavernous angioma, respectively. Holmes tremor usually occurred in 1-24 months after the initial insult and commonly involved contralateral upper limb. Brain MRI found that thalamus was involved solely in two patients, thalamus and midbrain were involved in the other two patients. Tremor analysis showed that peak frequency of tremor at rest, posture, intention and holding 1000 g was between 2.6-3.8 Hz. Halfwidth power of tremor at intention was higher than that at rest. The agonistic and antagonistic muscles mainly contracted synchronously at rest, while they mainly contracted alternately at posture, intention and holding 1000 g. Three patients showed remission in different degree after pramipexole treatment. Conclusions Holmes tremor is mainly caused by cerebrovascular disease with midbrain and thalamus lesion, with 2-4 Hz low frequency of tremor and obvious tremor at intension. Dopaminergic agonists may be effective for some patients.

Key words: Holmes tremor; Magnetic resonance imaging; Peak frequency; Half-width power

杨硕，陈娜，潘华，翦凡，张磊，王颖，陈琳，王恒恒. 脑血管疾病后Holmes震颤的临床、影像和电生理特点[J]. 中国卒中杂志, 2020, 15(04): 401-405.

YANG Shuo, CHEN Na, PAN Hua, JIAN Fan, ZHANG Lei, WANG Ying, CHEN Lin, WANG Heng-Heng. Clinical, Imaging and Electrophysiological Characteristics of Holmes Tremor Induced by Cerebrovascular Disease[J]. Chinese Journal of Stroke, 2020, 15(04): 401-405.

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