CAJ | 학술논문

目的利用血氧水平依赖功能性磁共振成像(fMRI)技术研究恢复期脑梗死患者运动相关皮质的激活代偿情况,探讨脑梗死后脑功能重组的规律.方法选取16例初发单侧放射冠和/或基底核区脑梗死患者作为研究对象,其中男12例,女4例;年龄37～80岁,平均(61.0±11.3)岁;病程1～3月,平均1.7个月.每位患者依次进行患侧、健侧腕关节被动屈伸运动,同时对患者进行fMRI检查.所得数据采用SPM2软件包进行离线后处理,比较所有患者健侧及患侧腕关节被动运动时大脑皮质激活情况.结果脑梗死患者患侧腕关节被动运动时较健侧运动时激活大脑皮质区域更多、范围更广,其中患侧腕关节被动运动时激活脑区特点如下:①主要运动皮质区(M1)激活缺失,仅4例出现对侧M1区激活,有5例出现同侧M1区激活;②非主要运动区明显激活,包括运动前区(PMC)、补充运动区(SMA)、扣带回运动区(CMA)、顶下小叶(IPL)、前额叶皮质(PFC)及小脑(CRB)等,并呈现双侧激活现象.健侧腕关节被动运动时主要激活对侧第一运动区(M1)、第一感觉区(S1)以及同侧CRB,有少数出现PMC、SMA、CMA及IPL激活,但均以对侧脑区激活为主.结论脑梗死后大脑皮质功能发生代偿性改变,包括主要运动区激活缺失,非主要运动区激活增加,并且运动区发生移位,有向周围扩展的趋势,另外还可见非运动区激活.
목적 이용혈양수평의뢰공능성자공진성상(fMRI)기술연구회복기뇌경사환자운동상관피질적격활대상정황,탐토뇌경사후뇌공능중조적규률.방법 선취16례초발단측방사관화/혹기저핵구뇌경사환자작위연구대상,기중남12례,녀4례;년령37～80세,평균(61.0±11.3)세;병정1～3월,평균1.7개월.매위환자의차진행환측、건측완관절피동굴신운동,동시대환자진행fMRI검사.소득수거채용SPM2연건포진행리선후처리,비교소유환자건측급환측완관절피동운동시대뇌피질격활정황.결과 뇌경사환자환측완관절피동운동시교건측운동시격활대뇌피질구역경다、범위경엄,기중환측완관절피동운동시격활뇌구특점여하:①주요운동피질구(M1)격활결실,부4례출현대측M1구격활,유5례출현동측M1구격활;②비주요운동구명현격활,포괄운동전구(PMC)、보충운동구(SMA)、구대회운동구(CMA)、정하소협(IPL)、전액협피질(PFC)급소뇌(CRB)등,병정현쌍측격활현상.건측완관절피동운동시주요격활대측제일운동구(M1)、제일감각구(S1)이급동측CRB,유소수출현PMC、SMA、CMA급IPL격활,단균이대측뇌구격활위주.결론 뇌경사후대뇌피질공능발생대상성개변,포괄주요운동구격활결실,비주요운동구격활증가,병차운동구발생이위,유향주위확전적추세,령외환가견비운동구격활.
Objective To investigate activation patterns in the motor cortex of patients with cerebral infarction by blood oxygen level dependent-functional magnetic resonance imaging ( BOLD-fMRI) , and to explore the brain's functional reorganization mechanism. Methods Sixteen patients ( 12 men and 4 women, age 37 to 80, mean 61.0±11.3) who had suffered a subcortical infarction within the previous 3 months were studied. All the patients received fMRI scanning during passive flexion-extension movement of both the affected and unaffected wrist separately.Brain functional mapping was acquired with SPM2 software. Activation patterns in the brain were compared between the affected and unaffected hands. Results The volume and intensity of the activated areas were diverse, but showed some order. When the affected hand moved, the fMRI map showed general hyperactivation. When the unaffected hand moved, the contralateral M1 and S1 were activated. Conclusions After cerebral infarction, the brain cortex showed compensatory changes. As the main motor cortex (M1) was deactivated, the subsidiary motor areas such as the PMC, SMA, CMA, IPL, PFC and CRB were activated. The activated motor areas could shift to the area around the lesion, and the non-motor area was activated also.