Nakamura M, Hamamoto M, Uchida S, Nagayama H, Amemiya S, Okubo S, Tanaka K
Department of Neurology, Tokyo Metropolitan Tama Geriatric Hospital, Tokyo, Japan.
Eur J Neurol. 2003 Sep;10(5):593-6. doi: 10.1046/j.1468-1331.2003.00641.x.
Most reports of micrographia associated with focal brain lesions have related this finding to damage in the left basal ganglia. Here we describe the case of a 68-year-old man presenting with reversible micrographia accompanied by hypophonia in the absence of extrapyramidal signs after cerebral infarction in the left subcortical region. At the time of the patient's admission, diffusion-weighted magnetic resonance imaging sequence showed the lesion to principally involve the corona radiata, with some involvement of the putamen. Neurologically, mild right-sided brachiofacial hemiparesis and grasp reflexes - a frontal lobe sign - were observed. As his micrographia and hypophonia improved, the patient's grasp reflexes improved in parallel. In addition, recovery of regional cerebral blood flow in the left frontal lobe was confirmed by single photon emission computed tomography (technetium-99 m HMPAO). The present case suggests the possibility that the function of frontal-subcortical circuit might also be involved in the production and improvement of micrographia and that micrographia and hypophonia may share a common pathophysiology.
大多数关于与局灶性脑病变相关的小写症的报告都将这一发现与左侧基底神经节的损伤联系起来。在此，我们描述了一名68岁男性的病例，该患者在左侧皮质下区域脑梗死之后，出现了可逆性小写症，并伴有发声减弱，且无锥体外系体征。在患者入院时，弥散加权磁共振成像序列显示病变主要累及放射冠，壳核也有部分受累。神经系统检查发现，患者存在轻度右侧臂面部偏瘫以及抓握反射——一种额叶体征。随着患者小写症和发声减弱症状的改善，其抓握反射也随之改善。此外，通过单光子发射计算机断层扫描（99m锝-六甲基丙二胺肟）证实了左侧额叶局部脑血流的恢复。本病例提示，额-皮质下环路的功能可能也参与了小写症的产生和改善过程，并且小写症和发声减弱可能具有共同的病理生理学机制。
