Dooling E C, Adams R D
Brain. 1975 Mar;98(1):29-48. doi: 10.1093/brain/98.1.29.
Disorders of movement after hemiplegia have been described for more than a century, but their pathological anatomy and physiology have remained poorly understood because of ambiguous terminology and incomplete studies. We examined the brains of 5 patients which had been serially sectioned where there had been well documented pure motor hemiplegia acquired in childhood. In 4 patients handicapped by hemiathetosis the main lesion was partial destruction of the caudate nucleus and putamen. In the fifth case, where non-disabling involuntary movements only appeared in later life, there was gliosis of the caudate nucleus and thalamus. Striatal lesions produce involuntary movement disorders if the corticospinal and other major motor tracts are partly intact. We propose that degeneration of the thalamic nuclei receiving striatal efferents (ventralis anterior, ventralis lateralis and centrum medianum), wheter primary or secondary, appears to remove an essential modulating influence on the corticospinal system which can only become manifest if this system is relatively preserved.
偏瘫后运动障碍已有一个多世纪的描述，但由于术语模糊和研究不完整，其病理解剖学和生理学仍未得到很好的理解。我们检查了5例患者的大脑，这些大脑已被连续切片，这些患者在儿童时期获得了有充分记录的纯运动性偏瘫。在4例因偏身颤搐-舞蹈症而致残的患者中，主要病变是尾状核和壳核的部分破坏。在第五例中，非致残性不自主运动仅在晚年出现，尾状核和丘脑有胶质增生。如果皮质脊髓和其他主要运动束部分完整，纹状体病变会导致不自主运动障碍。我们提出，接受纹状体传出纤维的丘脑核（腹前核、腹外侧核和中央中核）的退化，无论是原发性还是继发性，似乎都会消除对皮质脊髓系统的一种基本调节影响，只有当这个系统相对保留时，这种影响才会显现出来。
