【失禁play】从脑区分布看脑供血不足的症状有哪些？

顾建文，解放军第306医院，神经外科

脑血不足是中老年人最常见的脑血管疾病，通常与高脂血症、高血压、糖尿病等基础疾病引起的动脉硬化有关，动脉内动脉粥样斑块的形成会导致动脉狭窄，从而影响大脑的血液供应，引起神经系统的症状。

该病给患者的身心健康造成很大的危害，因此日常如果出现脑供血不足的症状时，还需及早治疗。下面是脑区分布

Intraparietal sulcus (IPS): 顶间沟

The IPS contains a series of functionally distinct subregions that have been intensively investigated using both single cell neurophysiology in primates and human functional neuroimaging.

Its principal functions are related to perceptual-motor coordination (for directing eye movements and reaching) and visual attention.

The IPS is also thought to play a role in other functions, including processing symbolic numerical information, visuospatial working memory and interpreting the intent of others.

Frontal Eye Fields (FEF)：前额眼区

The cortical area called frontal eye fields (FEF) plays an important role in the control of visual attention and eye movements. Electrical stimulation in the FEF elicits saccadic eye movements. The FEF have a topographic structure and represents saccade targets in retinotopic coordinates.

Frontal eye fields is roughly located between regions #4, #6, and #8

Temporoparietal Junction (TPJ): 顶枕联合

The TPJ incorporates information from the thalamus and the limbic system, as well as from the visual, auditory, and somatosensory systems. The TPJ also integrates information from both the external environment as well as from within the body.

This area is also known to play a crucial role in self-other distinctions processes andtheory of mind (ToM). Damage to the TPJ has been implicated in having adverse effects on an individual’s ability to make moral decisions and has been known to produce out-of-body experiences

Default mode network (DMN): 默认网络

DMN is a network of brain regions that are active when the individual is not focused on the outside world and the brain is at wakeful rest. Also called the default network, default state network, or task-negative network (TNN), it is characterized by coherent neuronal oscillations at a rate lower than 0.1 Hz (one every ten seconds). During goal-oriented activity, the DMN is deactivated and another network, the task-positive network (TPN) is activated. The default network may correspond to task-independent introspection, or self-referential thought, while the TPN corresponds to action, and that perhaps the TNN and TPN may be "considered elements of a single default network with anti-correlated components". A range of task negative processes have been proposed as functions of the DMN, including introspection, daydreaming, and memory recall. Age related changes in DMN connectivity seem to map onto age related changes in cognition, particularly during adolescence and old age. The extent of the DMN activation correlates with level of consciousness, providing a possible diagnostic tool for differentiating between conscious and non-conscious non-communicative brain-damaged patients.

Include: precuneus psoterior cingulate cortex (PCC) medial prefrontal cortex (MPFC) orbital prefrontal cortex (OPFC) inferior parietal cortex

Central executive network (CEN): 执行控制网络

Include:

dorsolateral prefrontal cortex (DLPFC)

posterior parietal cortex(PPC)

supplementary motor area(SMA)

轻度脑供血不足的症状表现

1、精神意识异常：整天昏昏沉沉，总是想睡，这是由于脑供血不足引起的，被视为先兆症状。少数患者表现为失眠，性格变化，如孤癖、沉默寡言或表情淡漠，有的多语急躁;有的可以出现短暂的意识丧失或智力衰退。

2、运动神经功能失灵：常表现为流口涎，失语或言语不清，吞咽困难，一侧肢体无力或活动不灵，走路不稳或突然跌跤。这些常为先兆症状，持续时间较短。

3、感觉功能障碍：患者可感觉到面麻、舌麻、唇麻;有的视物不清，甚至突然一时失明;不少人有突然眩晕感;还有的突然出现耳鸣、听力减退等。

以上这些症状较为轻微，很多人并不会过多关注，所以就给病情的恶化形成了机会，如果一旦形成脑供血不足，则会出现以下症状：

1、恶心呕吐或血压波动。整天昏昏沉沉的欲睡，表现为嗜睡状态。

2、脑供血不足患者一侧或某一肢体不自主地抽动。

3、头晕，特别是突感到眩晕。有时会出现突然原因不明的跌交或晕倒。

4、肢体麻木，突然感到一侧脸部或手脚麻木，有的为舌麻、唇麻。肢无力或活动不灵。短暂的意识丧失和智力的突然变化。

颈椎病所导致的脑供血不足的症状

1、颈型：枕颈部痛，颈活动受限，颈肌僵硬，有相应压痛点。

X线显示：颈椎在病变节段改变。

2、神经根型：颈椎伴上肢放射痛，颈后伸时加重，受压神经根皮肤节段分布区感觉减弱，腱反射减弱，肌萎缩，活动受限。

X线显示：椎体增生，钩椎关节增生明显，椎间隙变窄，椎间孔变小。

3、脊髓型：早期下肢发紧，行走不稳，晚期一侧下肢或四肢瘫痪，小便失禁或尿潴留，受压脊髓节段以下感觉障碍，肌张力增高，反射亢进，椎体束征阳性。

X线显示：椎间隙狭窄，椎体后缘增生较严重并突入椎管。

CT，MRI检查示：椎管变窄，椎体后缘增生物或椎间盘膨出压迫脊髓。

4、椎动脉型：脑供血不足、头痛眩晕，耳鸣，耳聋，视物不清，有体位性猝倒，颈椎侧弯后伸时症状加重。

CT显示：左右横突孔大小不对称，一侧相对狭窄，横突间距变小，钩椎关节增生。

5、交感神经型：眼脸无力，视力模糊，头痛，头晕，枕颈痛。

CT显示：色椎增生，椎间孔变狭窄，颈椎有不同程度错位，椎动脉有受压现象。

颈椎的不同部位患病所形成的供血不足症状也是有所差异，但无论具体是那种，对人体的危害都不可小觑，一旦发现就要及时去检查治疗。