血管性帕金森综合征患者小范围放射冠梗死后的不成比例延髓功能障碍：一例病例报告

文献信息

中文摘要

背景： 皮质下腔隙性梗死常见于脑小血管病，并导致老年人进行性功能衰退。放射冠梗死可能破坏汇聚的皮质延髓通路。在血管性帕金森综合征患者中，皮质下运动储备减少可能使延髓功能尤为脆弱，导致神经功能缺损与病灶大小不成比例。
患者主诉： 一名75岁患有血管性帕金森综合征的女性出现急性构音障碍、需鼻胃管喂养的严重吞咽困难以及明显的步态不稳。
诊断： 脑磁共振成像显示左侧放射冠小范围急性梗死，并叠加于广泛的脑小血管病之上。尽管梗死面积有限，她仍出现了严重的吞咽功能障碍和活动能力受损。
干预： 启动并维持早期多学科康复，包括言语-语言治疗、分级饮食推进和以平衡为导向的步态训练，持续整个3个月随访期。
结果： 在3个月随访时，患者表现出有意义的功能恢复，Barthel指数从35改善至75，功能性步行分级从1改善至4，吞咽困难结局与严重程度量表从2级改善至6级，从而得以拔除鼻胃管并恢复安全经口进食。
经验教训： 在血管性帕金森综合征并广泛脑小血管病患者中，即使小范围放射冠梗死也可能导致不成比例的严重延髓功能障碍。尽管皮质下运动储备减少，早期多学科康复仍与有意义的功能恢复相关。

英文摘要

RATIONALE: Subcortical lacunar infarctions commonly occur in cerebral small vessel disease and contribute to progressive functional decline in older adults. Infarction of the corona radiata may disrupt converging corticobulbar pathways. In patients with vascular parkinsonism, diminished subcortical motor reserve may render bulbar function particularly vulnerable, resulting in neurological deficits disproportionate to lesion size.
PATIENT CONCERNS: A 75-year-old woman with vascular parkinsonism presented with acute dysarthria, severe dysphagia requiring nasogastric tube feeding, and marked gait instability.
DIAGNOSES: Brain magnetic resonance imaging demonstrated a small acute infarction in the left corona radiata superimposed on extensive cerebral small vessel disease. Despite the limited infarct size, she developed profound swallowing dysfunction and impaired mobility.
INTERVENTIONS: Early multidisciplinary rehabilitation, including speech-language therapy, graded diet advancement, and balance-oriented gait training, was initiated and maintained throughout the 3-month follow-up period.
OUTCOMES: At the 3-month follow-up, the patient demonstrated meaningful functional recovery, with the Barthel Index improving from 35 to 75, the Functional Ambulation Category improving from 1 to 4, and the Dysphagia Outcome and Severity Scale improving from level 2 to level 6, allowing removal of the nasogastric tube and resumption of safe oral intake.
LESSONS: Even small corona radiata infarctions may cause disproportionately severe bulbar dysfunction in patients with vascular parkinsonism and extensive cerebral small vessel disease. Early multidisciplinary rehabilitation was associated with meaningful functional recovery despite diminished subcortical motor reserve.