顧建文，解放軍306醫院，神經外科

腦供血不足是中老年人最常見的腦血管疾病，通常與高血脂症、高血壓、糖尿病等基礎疾病引起的動脈硬化有關的，動脈內的粥樣斑塊形成 可以導致動脈狹窄，從而影響到大腦的血供，引起一些神經系統的癥狀。該病給患者的身心健康造成很大的危害，因此日常如果出現腦供血不足的癥狀時，還需及早治療。下面是腦區分布

Intraparietal sulcus (IPS): 頂間溝

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)：前額眼區

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): 頂枕聯合

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): 默認網路

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): 執行控制網路

Include:

dorsolateral prefrontal cortex (DLPFC)

posterior parietal cortex(PPC)

supplementary motor area(SMA)

輕度腦供血不足的癥狀表現

1、精神意識異常：整天昏昏沉沉，總是想睡，這是由於腦供血不足引起的，被視為先兆癥狀。少數患者表現為失眠，性格變化，如孤癖、沉默寡言或表情淡漠，有的多語急躁;有的可以出現短暫的意識喪失或智力衰退。

2、運動神經功能失靈：常表現為流口涎，失語或言語不清，吞咽困難，一側肢體無力或活動不靈，走路不穩或突然跌跤。這些常為先兆癥狀，持續時間較短。

3、感覺功能障礙：患者可感覺到面麻、舌麻、唇麻;有的視物不清，甚至突然一時失明;不少人有突然眩暈感;還有的突然出現耳鳴、聽力減退等。

以上這些癥狀較為輕微，很多人並不會過多關注，所以就給病情的惡化形成了機會，如果一旦形成腦供血不足，則會出現以下癥狀：

1、噁心嘔吐或血壓波動。整天昏昏沉沉的欲睡，表現為嗜睡狀態。

2、腦供血不足患者一側或某一肢體不自主地抽動。

3、頭暈，特別是突感到眩暈。有時會出現突然原因不明的跌交或暈倒。

4、肢體麻木，突然感到一側臉部或手腳麻木，有的為舌麻、唇麻。肢無力或活動不靈。短暫的意識喪失和智力的突然變化。

頸椎病所導致的腦供血不足的癥狀

1、頸型：枕頸部痛，頸活動受限，頸肌僵硬，有相應壓痛點。

X線顯示：頸椎在病變節段改變。

2、神經根型：頸椎伴上肢放射痛，頸後伸時加重，受壓神經根皮膚節段分布區感覺減弱，腱反射減弱，肌萎縮，活動受限。

X線顯示：椎體增生，鉤椎關節增生明顯，椎間隙變窄，椎間孔變小。

3、脊髓型：早期下肢發緊，行走不穩，晚期一側下肢或四肢癱瘓，小便失禁或尿瀦留，受壓脊髓節段以下感覺障礙，肌張力增高，反射亢進，椎體束征陽性。

X線顯示：椎間隙狹窄，椎體後緣增生較嚴重並突入椎管。

CT，MRI檢查示：椎管變窄，椎體後緣增生物或椎間盤膨出壓迫脊髓。

4、椎動脈型：腦供血不足、頭痛眩暈，耳鳴，耳聾，視物不清，有體位性猝倒，頸椎側彎後伸時癥狀加重。

CT顯示：左右橫突孔大小不對稱，一側相對狹窄，橫突間距變小，鉤椎關節增生。

5、交感神經型：眼臉無力，視力模糊，頭痛，頭暈，枕頸痛。

CT顯示：色椎增生，椎間孔變狹窄，頸椎有不同程度錯位，椎動脈有受壓現象。

頸椎的不同部位患病所形成的供血不足癥狀也是有所差異，但無論具體是那種，對人體的危害都不可小覷，一旦發現就要及時去檢查治療。

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