The syndrome of combined polar and paramedian thalamic infarction
The syndrome of combined polar and paramedian thalamic infarction
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DOI：
10.1001/archneur.62.8.1212
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发表时间：
2005-08-01
影响因子：
--
通讯作者：
Bogousslavsky, J
中科院分区：
文献类型：
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作者：
Perren, F;Clarke, S;Bogousslavsky, J
背景资料：丘脑的极动脉或旁正中动脉闭塞通常会导致明显的梗死，并与特定的临床和影像学相关。然而，血管变异是这样的，在多达三分之一的人类中，极动脉缺失，其领土被旁正中动脉所接管。目的：提供对丘脑极和旁正中联合梗死的相应卒中综合征的关注。方法：我们研究了12例合并极旁正中丘脑梗死的患者（6例右侧病变、3例左侧病变和3例双侧病变），这些患者是从洛桑卒中登记处连续登记的208例丘脑卒中患者中选出的。临床表现为执行功能障碍、情感淡漠、记忆障碍，10例伴有眼球运动障碍（5例右侧病变，2例左侧病变，3例双侧病变）; 11例患者急性意识受损右侧5例，左侧3例，双侧3例;失语症8例（2例右侧病变，3例左侧病变，3例双侧病变），包括1例非流利性失语（左侧病变）; 5例患者构音障碍（4例右侧病变，1例双侧病变）; 5例患者存在结构性失用症（右侧病变）; 4例患者轻度轻偏瘫（2例右侧病变，2例左侧病变）; 3例患者存在计算障碍（1例左侧病变，1例右侧病变，1例双侧病变）;肢体肌张力障碍或痉挛2例（1例右侧病变，1例双侧病变）-2例患者中1例轻度偏侧感觉丧失（1例右侧病变，1例左侧病变）; 1例患者发生偏侧共济失调（右侧病变）; 1例患者发生意识性失用症（左侧病变）。随访显示7例患者（4例右侧病变，3例双侧病变）严重致残，持续性遗忘，5例患者（2例右侧病变，1例左侧病变，2例双侧病变）持续性眼球运动功能障碍。最常见的病因似乎是carchoembolism，其次是artery-to-arterial栓塞和假定的小动脉diseases.Conclusions：这种综合征的主要特点包括健忘症之前的一段时间的意识改变，垂直眼运动障碍。严重和持续性的遗忘可能是由于前核和背内侧核的共同损害。
Background: Occlusion of the polar or the paramethan arteries of the thalamus usually leads to distinct infarcts with specific clinical and imaging correlates. However, vascular variation is such that in up to one third of humans, the polar artery is missing and its territory taken over by the paramedian arteries.Objective: To provide attention to the corresponding stroke syndrome of combined polar and paramedian thalamic infarction.Methods: We studied combined polar-paramedian thalamic infarction in 12 patients (6 right-sided lesions, 3 left-sided lesions, and 3 bilateral lesions) who were selected from 208 consecutively registered patients with thalamic strokes in the Lausanne Stroke Registry.Results: The clinical manifestation included executive dysfunction, apathy, and memory impairment in all patients, with eye movement disturbances in 10 patients (5 with right-sided lesions, 2 with left-sided lesions, 3 with bilateral lesions); acutely impaired consciousness in 11 patients (5 with right-sided lesions, 3 with leftsided lesions, 3 with bilateral lesions); aphasic disturbances in 8 patients (2 with right-sided lesions, 3 with left-sided lesions, 3 with bilateral lesions), including non-fluent aphasia in 1 patient (with left-sided lesions); dysarthria in 5 patients (4 with right-sided lesions, 1 with bilateral lesions); constructional apraxia in 5 patients (with right-sided lesions); mild hemiparesis in 4 patients (2 with right-sided lesions, 2 with left-sided lesions); dyscalculia in 3 patients (1 with left-sided lesions,1 with rightsided lesions, 1 with bilateral lesions); limb dystonia or asterixis in 2 patients (1 with right-sided lesions, 1 with bilateral lesions) -1 mild hemisensory loss in 2 patients (1 with right-sided lesions, 1 with left-sided lesions); hemiataxia in 1 patient (with right-sided lesions); and ideomotor apraxia in 1 patient (with left-sided lesions). Follow-up showed severely disabling, persistent amnesia in 7 patients (4 with right-sided lesions, 3 with bilateral lesions) and persistent eye movement dysfunction in 5 patients (2 with right-sided lesions, 1 with left-sided lesions, 2 with bilateral lesions). The most common etiology appeared to be carchoembolism, followed by artery-toartery embolism and presumed small-artery disease.Conclusions: Key features of this syndrome included amnesia preceded by a period of altered consciousness, and vertical eye movement disturbances. The severe and persistent amnesia may be due to coexisting damage to the anterior and dorsomedial nuclei.