脑小血管病与步态障碍相关性研究进展

doi:10.3969/j.issn.1673-5765.2018.11.019

摘要/Abstract

摘要：

脑小血管病的影像改变包括脑白质高信号、腔隙性脑梗死、血管周围间隙、脑微出血、脑萎缩等。步态障碍是脑小血管病的重要临床特征，进一步导致跌倒风险增加。脑小血管病破坏脊髓运动系统和皮层、基底节纤维联系的完整性，同时存在视空间和执行功能障碍、抑郁状态等多种认知或精神心理障碍，均与步态异常显著相关。在步态障碍的上述产生机制中，侧脑室周围、额叶深部白质疏松与运动协调和认知损伤相关；腔隙性脑梗死常见于运动-认知风险人群；血管周围间隙、一定数量的脑微出血、脑萎缩或脑灌注异常等均会导致认知损伤相关步态障碍。本文根据近期研究进展，以不同的临床或影像特征为基础，对脑小血管病导致步态障碍的发病机制进行详细综述。

文章导读： 本文总结了脑白质高信号、腔隙性脑梗死、血管周围间隙、脑微出血、脑萎缩等不同表现的脑小血管病对步态影响的机制和临床特点。

关键词: 脑小血管病; 步态障碍; 跌倒; 认知障碍; 抑郁

Abstract:

Gait disorder is an important clinical feature of cerebral small vessel disease (CSVD), and can lead to accidental tumble. Imaging features of CSVD include white matter hyperintensities, lacunar infarction, perivascular spaces, cerebral microbleeds, brain atrophy, abnormal cerebral perfusion, and so on. Broken integrality of spinal cord connection with cortex and basal ganglia, visuospatial and execution function dysfunction, together with cognitive impairment or depression in CSVD were all related to gait disorders. White matter hyperintensities in periventricular and deep frontal lobe can lead to motor coordination and cognitive impairment. Lacunar infarction are often found in those with high risk of motor and cognitive impairment. Perivascular spaces, a degree of cerebral microbleeds, brain atrophy and abnormal cerebral perfusion all can bring about gait disorders related to cognitive impairment. Based on clinical and imaging characteristics, this article reviewed the pathogenesis of gait disorders in CSVD.

Key words: Cerebral small vessel disease; Gait disorder; Tumble; Cognitive impairment; Depression

柴湘婷, 王祥翔, 张瑞霞, 马玲丽, 谭兰. 脑小血管病与步态障碍相关性研究进展[J]. 中国卒中杂志, 2018, 13(11): 1223-1229.

CHAI Xiang-Ting, WANG Xiang-Xiang, ZHANG Rui-Xia, MA Ling-Li, TAN Lan. Advance in Gait Disorder in Cerebral Small Vessel Disease[J]. Chinese Journal of Stroke, 2018, 13(11): 1223-1229.

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