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目的观察1例右侧半球大面积脑梗死所致偏侧空间忽略症患者的不同感觉通道、空间参考框架的表现,以及行为学和经颅磁刺激(TMS)治疗后的效果。方法采用行为学忽略测试中的线条划销、字母划销、星星划销、二分线段测试评定患者的视觉通道,临摹左右并列的2个图形测试患者的空间参考框架特点。同时进行听觉通道(左、右耳听手指撮捻声)、触觉通道(左、右手指被碰触)的偏侧空间忽略症检查。采用常规行为学和低频TMS刺激左半球顶下小叶进行2周(10次,1次/d,20 min/次)的偏侧空间忽略症治疗。结果①该患者治疗前的线条划销、字母划销、星星划销测试均显示,左侧空间内完成划销的数量低于右侧空间,差异有统计学意义,P<0.01。二分线段测试也表现为标记的中点明显偏右。②图形临摹显示患者不仅忽略了左侧空间的刺激(物体),也忽略了右侧空间内刺激(物体)的左半内容。③听觉通道、触觉通道忽略症检查也显示,对于左侧空间的听觉、触觉刺激的探查能力低于右侧,差异有统计学意义,P<0.01。④经2周治疗后,患者划销测试和图形临摹均较治疗前得到改善(P<0.05,P<0.01)。结论右侧半球大面积脑梗死可导致不同感觉通道和空间参考框架的偏侧空间忽略症。两周行为学和低频TMS治疗对改善偏侧空间忽略症有效。
Objective To observe the different sensory channels, the spatial reference frame and the effects of behavioral and transcranial magnetic stimulation (TMS) in one case of neglecting lateral space neglect in the right hemisphere. Methods Using the method of neglecting behavior in line delineation, letter demarcation, star demarcation and dichotomy, the visual channel of patients was evaluated, and the spatial reference frame characteristics of two patients were tested. At the same time auditory access (left and right ears to listen to pinch twisting sound), tactile channel (left and right fingers were touched) side of the neglect of space inspection. Conventional behavior and low-frequency TMS were used to stimulate the lateral lobes of the left hemisphere for 2 weeks (10 times, 1 time / d, 20 min / times). Results ① Before the treatment, the patients had the line demarcation, the letter demarcation and the star decontamination test all showed that the quantity of the demarcation in the left space was lower than that in the right space, the difference was statistically significant (P <0.01). The dichotomous segment test also showed markedly rightward deviation of the midpoint of the marker. ② Graphical copying showed that the patient not only ignored the stimulus (object) in the left space but also ignored the left half of the stimulus (object) in the right space. ③ auditory pathway, tactile channel neglect examination also showed that the left side of the auditory and tactile stimulation of exploration ability is lower than the right side, the difference was statistically significant, P <0.01. ④ After 2 weeks of treatment, the patients’ marketing test and graphic copy were improved compared with before treatment (P <0.05, P <0.01). Conclusion The right hemisphere large area cerebral infarction can lead to the neglect of lateral space in different sensory channels and spatial reference frames. Two-week behavioral and low-frequency TMS treatment to improve the lateral space negligence effective.