Montaner J, Alvarez-Sabín J, Molina C, Abilleira S, Rovira A
Unidad Cerebrovascular, Hospital Vall d'Hebron, Barcelona, España.
Rev Neurol. 1999;29(12):1181-4.
Acute pseudobulbar palsy produced by bilateral cerebral infarctions is a rare syndrome, which includes among its symptoms mutism, severe dysphagia and diverse sensory-motor signs.
We report two middle-aged patients who suddenly developed a severe dysarthria and dysphagia, which impeded their ability to speak and to feed themselves, with spasmodic laughing and crying and slight motor deficit ('pure' pseudobulbar palsy). The acute lesions, using conventional and diffusion-weighted magnetic resonance imaging, corresponded partially to the anterior choroidal artery (case 1: acute lesion in the left periventricular white matter and a subacute one in the right semioval centrum; case 2: acute lesions in the right frontal subcortical white matter and in the periventricular white matter adjacent to the left lateral ventricle). The favorable evolution of these patients in contrast to previously described patients with acute pseudobulbar palsy could indicate that the motor deficit is a prognostic factor for this syndrome.
Diffusion-Weighted magnetic resonance imaging permits differentiation with high precision of the acute lesions in patients who present old ones. Sometimes multiple acute lacunar infarctions (MALI) are found to be responsible of the syndrome. Hypertension and diabetes are the risk factors for the small vessel disease underlying these MALI.
双侧脑梗死所致急性假性球麻痹是一种罕见综合征，其症状包括缄默症、严重吞咽困难及多种感觉运动体征。
我们报告了两名中年患者，他们突然出现严重构音障碍和吞咽困难，导致无法说话和自主进食，伴有痉挛性哭笑及轻微运动功能缺损（“纯”假性球麻痹）。通过常规磁共振成像和弥散加权磁共振成像检查发现，急性病灶部分对应脉络膜前动脉（病例1：左侧脑室周围白质急性病灶，右侧半卵圆中心亚急性病灶；病例2：右侧额叶皮质下白质及左侧脑室旁脑室周围白质急性病灶）。与先前报道的急性假性球麻痹患者相比，这两名患者病情转归良好，提示运动功能缺损可能是该综合征的一个预后因素。
弥散加权磁共振成像能够高精度鉴别存在陈旧病灶患者的急性病灶。有时发现多发性急性腔隙性脑梗死（MALI）是该综合征的病因。高血压和糖尿病是这些MALI所潜在的小血管疾病的危险因素。
