Pendlebury S T, Blamire A M, Lee M A, Styles P, Matthews P M
Centre for Functional MRI of the Brain (FMRIB), John Radcliffe Hospital, and the Department of Clinical Neurology, The Radcliffe Infirmary (S.T.P., M.A.L., P.M.M.), and the MRC Magnetic Resonance Spectroscopy Unit, John Radcliffe Hospital (A.
Stroke. 1999 May;30(5):956-62. doi: 10.1161/01.str.30.5.956.
Background and Purpose--Magnetic resonance spectroscopy (MRS) in ischemic stroke has shown a correlation between N-acetylaspartate (NAA) loss from the infarcted region and disability. We tested the hypothesis that NAA loss in the descending motor pathways, measured at the level of the posterior limb of the internal capsule, would determine motor deficit after a cortical, subcortical, or striatocapsular stroke. Methods--Eighteen patients with first ischemic stroke causing a motor deficit were examined between 1 month and 5 years after stroke. T2-weighted imaging of the brain and localized proton (voxel, 1.5x2x2 cm3) MRS from the posterior limb of each internal capsule were performed and correlated to a motor deficit score. Results--Mean internal capsule NAA was significantly lower in the patient group as a whole compared with the control group (P<0.001). Reductions in internal capsule NAA on the side of the lesion were seen in cases of cortical stroke in which there was no extension of the stroke into the voxel as well as in cases of striatocapsular stroke involving the voxel region. There was a strong relationship between reduction in capsule NAA and contralateral motor deficit (log curve, r2=0.9, P<0.001). Conclusions--Axonal injury in the descending motor pathways at the level of the internal capsule correlated with motor deficit in patients after stroke. This was the case for strokes directly involving the internal capsule and for strokes in the motor cortex and subcortex in which there was presumed anterograde axonal injury.
背景与目的——缺血性卒中的磁共振波谱分析（MRS）显示梗死区域N-乙酰天门冬氨酸（NAA）缺失与残疾之间存在相关性。我们检验了这样一个假设，即在大脑内囊后肢层面测量的下行运动通路中NAA缺失，将决定皮质、皮质下或纹状体-内囊卒中后的运动功能缺损。方法——对18例首次发生缺血性卒中并导致运动功能缺损的患者在卒中后1个月至5年进行检查。对大脑进行T2加权成像，并对每个内囊后肢进行局部质子（体素，1.5×2×2 cm3）MRS检查，并将其与运动功能缺损评分进行关联。结果——与对照组相比，整个患者组的平均内囊NAA显著降低（P<0.001）。在皮质卒中且卒中未延伸至体素区域的病例以及累及体素区域的纹状体-内囊卒中病例中，均可见病变侧内囊NAA降低。内囊NAA降低与对侧运动功能缺损之间存在密切关系（对数曲线，r2=0.9，P<0.001）。结论——内囊层面下行运动通路的轴突损伤与卒中后患者的运动功能缺损相关。对于直接累及内囊的卒中以及运动皮质和皮质下卒中（推测存在顺行性轴突损伤）均是如此。
