Hiraga Akiyuki, Uzawa Akiyuki, Tanaka Saiko, Ogawara Kazue, Kamitsukasa Ikuo
Department of Neurology, Chiba Rosai Hospital, 2-16 Tatsumidai-Higashi, Ichihara-shi, Chiba 290 0003, Japan.
J Clin Neurosci. 2009 Nov;16(11):1414-6. doi: 10.1016/j.jocn.2009.01.015. Epub 2009 Jul 7.
Pure monoparesis of the leg due to cerebral infarction is rare compared to that of the hand. The anterior cerebral artery (ACA) territory is the most common lesion site in leg monoparesis, but diffusion-weighted (DW) MRI has not commonly been used for lesion detection. The purpose of this study was to use DW MRI to evaluate the radiological correlation with lesion location in patients presenting with pure leg monoparesis. We retrospectively studied six cerebral infarct patients with pure leg monoparesis who had undergone DW MRI. Patients were scanned within 3 days of symptom onset. DW MRI identified lesions in the posterior limb of the internal capsule (PLIC) in two patients, in the corona radiata (two patients), in the subcortical white matter of the posterior frontal lobe (one patient), and in the frontal and parietal cortex, including the paracentral lobule and precuneus (one patient). The two patients with PLIC infarctions had characteristic linear infarction abnormalities along the long axis of the internal capsule. Corona radiata infarction were located posteriorly, and the two subcortical and cortical infarction were thought to be in the territory of the ACA. We thus concluded that in leg monoparesis due to infarctions, lesions may be located in the PLIC, corona radiata, or in the ACA territory. Recently, magnetic resonance tractography has shown that foot fibres of the corticospinal tract in the PLIC somatotopically may be posteromedial to hand fibres along the short axis of the internal capsule, rather than posterolateral along the long axis as has been thought. Thus, damage along the long axis of the PLIC by linear infarctions can cause pure monoparesis of the leg.
与手部相比,因脑梗死导致的单纯腿部单瘫较为罕见。大脑前动脉(ACA)供血区是腿部单瘫最常见的病变部位,但扩散加权(DW)磁共振成像(MRI)通常未用于病变检测。本研究的目的是使用DW MRI评估单纯腿部单瘫患者病变位置的影像学相关性。我们回顾性研究了6例接受DW MRI检查的单纯腿部单瘫脑梗死患者。患者在症状出现后3天内进行扫描。DW MRI在两名患者的内囊后肢(PLIC)、两名患者的放射冠、一名患者的额后叶皮质下白质以及一名患者的额叶和顶叶皮质(包括中央旁小叶和楔前叶)发现了病变。两名PLIC梗死患者在内囊长轴上有特征性的线性梗死异常。放射冠梗死位于后方,另外两名皮质下和皮质梗死被认为位于ACA供血区内。因此,我们得出结论,在因梗死导致的腿部单瘫中,病变可能位于PLIC、放射冠或ACA供血区内。最近,磁共振纤维束成像显示,PLIC内皮质脊髓束的足部纤维在沿内囊短轴的躯体定位上可能在手部纤维的后内侧,而非如之前所认为的沿长轴在后外侧。因此,沿PLIC长轴的线性梗死造成的损伤可导致单纯腿部单瘫。