The course of corticofacial projections in the human brainstem
The course of corticofacial projections in the human brainstem
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DOI：
10.1093/brain/124.9.1866
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发表时间：
2001-09-01
期刊：
影响因子：
14.5
通讯作者：
Hopf, HC
中科院分区：
文献类型：
--
作者：
Urban, PP;Wicht, S;Hopf, HC
采用经颅磁刺激研究了 53 例因不同脑干水平的单灶性缺血性病变而导致中枢性面瘫（n = 28）和无中枢性面瘫（n = 25）的患者的皮质面部投射。 MRI 研究记录的病变地形与电生理学结果相关。在大多数患者中，皮质面纤维在脑桥的腹内侧基底内行进并在面核水平穿过中线。然而，在某些个体中，我们发现证据表明，皮质舌纤维在脑桥基部背侧边缘的脑膜旁位置形成“异常束”。在其他患者中，皮质面纤维向下循环进入上髓质的腹侧部分，穿过中线并在背外侧髓质区域上升到面核的同侧。研究结果表明，脑干病变引起的面瘫可能表现为大脑脚、脑桥基底部、异常束和腹延髓病变所致的对侧核上性面瘫。病变侧同侧的核上性面瘫可能由外侧髓质病变引起，核上型面瘫可能由背外侧髓质周围面神经病变并累及脑桥下部所致。
Transcranial magnetic stimulation was used to investigate the corticofacial projections in 53 patients with (n = 28) and without (n = 25) central facial paresis due to unifocal ischaemic lesions at different brainstem levels. Lesion topography documented by MRI studies was correlated with the electrophysiological findings. In the majority of patients the corticofacial fibres travel within the ventromedial base of the pons and cross the midline at the level of the facial nucleus. In some individuals, however, we found evidence that corticolingual fibres form an `aberrant bundle' in a paralemniscal position at the dorsal edge of the pontine base. In other patients the corticofacial fibres loop down into the ventral part of the upper medulla, cross the midline and ascend in the dorsolateral medullary region ipsilaterally to the facial nucleus. The findings suggest that facial paresis due to a brainstem lesion may present as contralateral supranuclear facial paresis by a lesion of the cerebral peduncle, pontine base, the aberrant bundle and the ventral medulla. Supranuclear facial paresis ipsilateral to the lesion side may result from a lesion in the lateral medulla, and facial paresis of the supranuclear type may be imitated by a lesion of the peripheral facial nerve in the dorsolateral medulla with involvement of the lower pons.