中文摘要：

目的：前瞻性应用磁共振弥散张量成像（DTI）技术,动态观察皮质下局灶性放射冠脑梗死后,豆状核继发性损害的过程,并探讨其与神经功能恢复及血管性帕金森发生的关系。方法：连续收集单侧单一放射冠脑梗死患者18例作为研究组,同时选择年龄、性别与研究组患者相匹配的健康志愿者18例作为对照组。分别在发病的第1、第4和第12周利用DTI对患者头部进行扫描,同时用简式Fugl-Meyer（FM）运动功能评分、Barthel生活指数（BI）和美国国立研究院卒中量表（NIHSS）对患者的运动功能、神经功能缺损程度以及日常生活能力进行评估,在发病的第12周,采用统一帕金森氏病综合评分量表（UPDRS）的第Ⅲ分量表评价出现类似帕金森病症状患者的严重程度。结果：发病第1、第4和第12周远离梗死灶的同侧豆状核平均弥散量（MD）值逐渐增加（P〈0.01）,各向异性（FA）值无明显变化（P〉0.05）;病灶对侧各时点FA值及MD值无明显差异（P〉0.05）;同侧豆状核MD值增加的百分数与NIHSS评分减少的百分数呈负相关关系（r=-0.694,P〈0.01）,与BI变化的百分数呈正相关关系（r=0.662,P〈0.05）,与FM增加的百分数无明显相关关系（r=0.489,P〉0.05）;研究组患者中3例出现帕金森样症状,与无帕金森病样症状的患者相比,梗死灶同侧豆状核的MD值显著升高（P〈0.05）,且同侧豆状核MD值上升幅度与其帕金森病样症状的严重程度呈正相关关系（r=0.486,P〈0.05）。结论：局灶性放射冠脑梗死后继发的豆状核损害会随时间延长而逐渐加重;其可能阻碍患者神经功能的恢复,还可能参与了血管性帕金森综合征的发病过程。

英文摘要：

Objective：To observe the dynamic process of the secondary degeneration in lentiform nucleus following a focal corona radiate infarct with diffusion tensor imaging （DTI）, and explore the relationship between the secondary degeneration and the time course of patients＇ rehabilitation. Methods： 18 patients with an acute infarct at unilateral corona radiata were selected and defined as a study group. And 18 healthy age- and gender-matched volunteers were enrolled as a control group. The degree of nervous functional defects, motor function and activity of daily living were assessed by National Institutes of Health Stroke Scale （NIHSS） scores, Fugl-Meyer assessment and Barthel index （BI）, respectively. Unified Parkinson＇s disease rating scale （UPDRS） was used to evaluate the Parkinson-like symptoms. Results. From the first week （Wl） to the 12th week （W12）, the mean diffusivity （MD） of lentiform nuclear in ipsilateral side was gradually increased （ P 〈0.01）, while the anisotropy （FA） showed no significant change （ P 〉0.05）. MD and FA values in contralateral side of lentiform nucleus also had no obvious change （ P 〉0. 05）. The increased percentage of MD in ipsilateral side of lentiform nucleus was negatively related to the reduced percentage of NIHSS score （ r = -0. 694, P 〈0.01）, and was positively correlated to the increased percentage of BI （ r =0. 662, P〈 0.05）, but was not related to the increased percentage of FM （r =0.489, P〉0.05）. Compared with the 3 patients without Parkinson-like symptoms, MD value of lentiform nucleus in ipsilateral side was increased （P〈0.05）. And MD value was positively correlated to the scores of UPDRS （r =0.486, P 〈0.05）. Conclusion. A focal corona radiate infarct may cause secondary degeneration in ipsilateral side of lentiform neuleus, and gradually worsened. The secondary degeneration may hinder the restoration of neural function and participate in the process of vascular Parkinson＇s syndrome.