脑积水脑室-腹腔分流术后帕金森综合征三例临床分析

目的探讨脑积水脑室-腹腔分流术后帕金森综合征的临床表现、影像学特点、可能的发病机制和治疗方法。方法与结果共3例脑积水患者均行脑室-腹腔分流术,1例于第2次术后1个月出现帕金森综合征,再次行脑室-腹腔分流术后症状缓解不明显,予左旋多巴和苄丝肼;1例于术后17年出现颈部僵直、动作迟缓,予舒必利后短期内症状明显加重,停药后无改善;1例于术后5个月出现言语减少、动作迟缓,予奥氮平后症状明显加重。3例患者头部CT和（或）MRI均显示侧脑室呈扩大-缩小波动性变化,临床诊断为帕金森综合征（脑室-腹腔分流术后）,予左旋多巴和苄丝肼后症状明显缓解。结论帕金森综合征是脑积水脑室-腹腔分流术后罕见并发症,可能是侧脑...

Full description

Saved in:
Bibliographic Details
Published in中国现代神经疾病杂志 Vol. 17; no. 2; pp. 127 - 132
Main Author 李胜德 王琳 关鸿志 魏俊吉 彭斌 万新华
Format Journal Article
LanguageChinese
Published 100730,中国医学科学院北京协和医学院北京协和医院神经科%100730,中国医学科学院北京协和医学院北京协和医院神经外科 2017
Subjects
帕金森障碍
手术后并发症
脑室腹膜分流术
脑积水
脑室腹膜分流术
Parkinsonian disorders
手术后并发症
Hydrocephalus
Ventriculoperitoneal shunt
脑积水
帕金森障碍
Postoperative complications
Online AccessGet full text
ISSN1672-6731
DOI10.3969/j.issn.1672-6731.2017.02.008

Cover

More Information
Summary:目的探讨脑积水脑室-腹腔分流术后帕金森综合征的临床表现、影像学特点、可能的发病机制和治疗方法。方法与结果共3例脑积水患者均行脑室-腹腔分流术,1例于第2次术后1个月出现帕金森综合征,再次行脑室-腹腔分流术后症状缓解不明显,予左旋多巴和苄丝肼;1例于术后17年出现颈部僵直、动作迟缓,予舒必利后短期内症状明显加重,停药后无改善;1例于术后5个月出现言语减少、动作迟缓,予奥氮平后症状明显加重。3例患者头部CT和（或）MRI均显示侧脑室呈扩大-缩小波动性变化,临床诊断为帕金森综合征（脑室-腹腔分流术后）,予左旋多巴和苄丝肼后症状明显缓解。结论帕金森综合征是脑积水脑室-腹腔分流术后罕见并发症,可能是侧脑室扩大-缩小波动性变化引起黑质纹状体通路损害所致,予多巴胺D2受体阻断剂可因＂双重打击＂致短期内帕金森样症状加重。多数患者多巴胺能药物治疗有效。
Bibliography:Objective To explore the clinical presentations,imaging features,probablepathogenesis and therapy of parkinsonism following ventriculoperitoneal shunt（VPS） in hydrocephalus.Methods and Results There were 3 cases of parkinsonism following VPS in hydrocephalus.Case 1presented parkinsonism one month after the second ventricular shunt,which was not relieved by anotherVPS,and was then treated by levodopa and benserazide.Case 2 developed neck rigidity and bradykinesia17 years after VPS.Symptoms worsened shortly after taking sulpiride and did not improved with sulpiridecessation.Bradykinesia and decreased speech occurred 5 months after VPS in Case 3,and parkinsonismaggravated rapidly on the following day after taking olanzapine.CT and/or MRI of 3 cases showedfluctuating change（enlarging-shrinking） of lateral ventricles.They were diagnosed as parkinsonismfollowing VPS,and responded well to levodopa and benserazide.Conclusions Parkinsonism,a rarecomplication following VPS in hydrocephalus,may result from interruption
ISSN:1672-6731
DOI:10.3969/j.issn.1672-6731.2017.02.008