小腦中風之排尿障礙：病例報告

Voiding Dysfunction in Cerebellar Stroke: A Case Report

何啟中(Chi-Chung Ho) ； 黃玉慧(Yu-Hui Huang) ； 蔡素如(Su-Ju Tsai) ； 簡可欣(Ko-Shin Jian) ； 高永亮(Yung-Liang Kao) ； 畢柳鶯(Liu-Ing Bih)

《台灣復健醫學雜誌》 37卷1期 (2009/03) Pp. 67-72

https://doi.org/10.6315/2009.37(1)08

摘要

過去有關小腦病變造成的排尿障礙臨床報告不多，其神經生理的研究也僅有少數動物實驗的報告。動物研究的結論是小腦在蓄尿期抑制膀胱收縮，在排尿期促進膀胱收縮，小腦可能經由大腦或腦幹的連結對膀胱有調節的作用。本篇報告一位因動靜脈畸形造成小腦大範圍出血的病例，在發病早期病人無法排尿，尿動力學檢查顯示逼尿肌不反射。拔除導尿管給予間歇導尿排尿訓練後一週，病人開始有自己排尿的能力，且可以忍尿，殘尿量也逐漸減少。後續追蹤的尿動力學檢查顯示逼尿肌過度反射合併間歇性外括約肌不協調收縮，可以解釋病人頻尿、尿急的症狀，病人排尿雖有困難，排尿功能卻明顯進步。回顧文獻沒有類似的案例報告，本病例的診斷及治療過程可供臨床照顧之參考。

關鍵字

小腦中風 ； 尿動力學 ； 神經性排尿障礙

並列摘要

Animal studies have suggested that the cerebellum plays an inhibitory role in the collecting phase and a facilitatory role in the emptying phase of the voiding reflex in the micturition cycle.
A 12 year old girl was admitted who complained of a headache and had a disturbance in consciousness after running in school. An emergent brain computed tomography scan showed massive bleeding over bilateral cerebellum hemispheres, vermis, and ventricles. An occipital craniotomy was performed to remove the hematoma. Simultaneously, an arterio-venous malformation was found and excised. She regained consciousness 3 weeks later, thereafter urine retention was noted as well as trunkal ataxia, upper and lower limb dysmetria, dysarthria, and dysphagia. Videourodynamic studies (VUD), performed 4 months after the onset of the stroke, showed detrusor areflexia with intermittent external sphincter contractions. An intermittent catheterization program was administered and voluntary urination began one week later. Though frequent urination and urgency were noted, she remained continent and the amount of residual urine decreased gradually. A followed up VUD at 6 weeks revealed detrusor hyperreflexia, which occurred in a bladder volume of 126 ml with an intravesical pressure of 95 cmH2O. In addition, intermittent detrusor external sphincter dyssynergia was detected.
Upon a review of the literature, there were few reports examining neurogenic voiding dysfunction after cerebellum lesion. This case study exhibited detrusor areflexia in the acute stage of a cerebellum lesion, detrusor hyperreflexia in recovery phase, and a positive outcome after bladder training.

並列關鍵字

cerebellar stroke ； urodynamics ； neurogenic bladder dysfunction