Szirmai Imre, Vastagh Ildikó, Szombathelyi Eva, Kamondi Anita
Department of Neurology, Faculty of Medicine, Semmelweis University, Balassa u. 6., 1083 Budapest, Hungary.
J Neurol Sci. 2002 Nov 15;203-204:91-7. doi: 10.1016/s0022-510x(02)00273-3.
Strategic infarcts or focal hemorrhages involving the paramedian nuclei of the thalamus may alter consciousness and produce complex neuropsychological symptoms such as impairment of memory, attention and motivation. Lesions disrupting the thalamo-prefrontal circuits lead to severe subcortical dementia. We analysed here the clinical, neuropsychological and neuroimaging data of 19 patients with cerebrovascular lesions in the thalamus. In six patients with bilateral paramedian infarcts, and in two with anterior thalamic infarcts, vascular dementia and severe personality changes developed. SPECT findings did not correlate with the neuropsychological symptoms. Transcortical sensory and motor aphasia was observed in four patients with thalamic hemorrhages and infarcts. In these patients SPECT detected hypoperfusion in adjacent cortical areas. Clinical symptoms and outcome of four patients are reported in detail. The clinico-morphological correlations of the thalamo-cortical circuits are reviewed and the possible causes of multiple cognitive and behavioural consequences of vascular thalamic lesions are discussed.
累及丘脑旁正中核的战略性梗死或局灶性出血可能会改变意识，并产生复杂的神经心理学症状，如记忆、注意力和动机受损。破坏丘脑 - 前额叶回路的病变会导致严重的皮质下痴呆。我们在此分析了19例丘脑脑血管病变患者的临床、神经心理学和神经影像学数据。在6例双侧旁正中梗死患者和2例丘脑前梗死患者中，出现了血管性痴呆和严重的人格改变。单光子发射计算机断层扫描（SPECT）结果与神经心理学症状不相关。在4例丘脑出血和梗死患者中观察到经皮质感觉性和运动性失语。在这些患者中，SPECT检测到相邻皮质区域灌注不足。详细报告了4例患者的临床症状和结局。回顾了丘脑 - 皮质回路的临床形态学相关性，并讨论了丘脑血管病变导致多种认知和行为后果的可能原因。
