1例32岁女性右侧脑出血患者发病后8和11个月皮质脊髓束弥散张量成像
（黄色和红色分别为左侧和右侧大脑半球皮质脊髓束）
步态异常是脑卒中最严重的后遗症之一。如何使脑卒中患者恢复正常的步态是神经康复领域的重要研究课题之一。事实上，脑卒中患者对步态恢复程度的要求不如手功能那么高，因为髋和膝关节运动功能恢复时，其即可在一定程度上抵抗重力作用行走。总体来说，大多数脑卒中患者运动功能恢复发生在发病后3-6个月，行走功能恢复一般发生在发病后3个月。因此临床医师要尤其关注那些脑卒中发病后3-6个月，步态异常仍没什么改善的患者。韩国岭南大学医学院Sung Ho Jang领导的团队报道了1例脑出血后8-11个月步态延迟恢复的病例。该患者为32岁女性，动静脉畸形破裂致右侧脑出血后行开颅和引流。大脑MRI显示，右侧顶额叶皮质损害。发病后8个月，弥散张量成像显示右侧皮质脊髓束严重损伤。同时，虽然患者从发病后2个月开始行康复干预，但仍不能站立和行走。左腿和右踝的严重痉挛是导致这一结果的原因。经过抗痉挛药物和康复干预后，痉挛得以控制，患者能够站立。另外，患者感觉运动功能、空间视觉功能、认知功能的改善也有助于步态的恢复。最终发病后11个月，患者能够在平坦的地面上行走。提示临床医师应该找到脑卒中后3-6个月仍不能行走的步态延迟恢复的原因，才能更好的制定有针对性的康复措施。相关文章发表于2013年6月第16期《中国神经再生研究（英文版）》杂志上。（生物谷 Bioon.com）
生物谷推荐的英文摘要
Neural Regeneration Research DOI: 10.3969/j.issn.1673-5374.2013.16.008
Delayed gait recovery in a stroke patient
Jeong Pyo Seo, Mi Young Lee, Yong Hyun Kwon, Sung Ho Jang
We report on a stroke patient who showed delayed gait recovery between 8 and 11 months after the onset of intracerebral hemorrhage. This 32-year-old female patient underwent craniotomy and drainage for right intracerebral hemorrhage due to rupture of an arteriovenous malformation. Brain MR images revealed a large leukomalactic lesion in the right fronto-parietal cortex. Diffusion tensor tractography at 8 months after onset revealed that the right corticospinal tract was severely injured. At this time, the patient could not stand or walk despite undergoing rehabilitation from 2 months after onset. It was believed that severe spasticity of the left leg and right ankle was largely responsible, and thus, antispastic drugs, antispastic procedures (alcohol neurolysis of the motor branch of the tibial nerve and an intramuscular alcohol wash of both tibialis posterior muscles) and physical therapy were tried to control the spasticity. These measures relieved the severe spasticity, with the result that the patient was able to stand at 3 months. In addition, the improvements in sensorimotor function, visuospatial function, and cognition also seemed to contribute to gait recovery. As a result, she gained the ability to walk independently on even floor with a left ankle foot orthosis at 11 months after onset. This case illustrates that clinicians should attempt to find the cause of gait inability and to initiate intensive rehabilitation in stroke patients who cannot walk at 3–6 months after onset.
