Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital, Tübingen, Germany.
Semin Perinatol. 2010 Feb;34(1):87-92. doi: 10.1053/j.semperi.2009.10.009.
The developing human brain possesses a superior capacity to reorganize after focal lesions. This review describes mechanisms of reorganization following pre- and perinatally-acquired, unilateral brain lesions for motor, somatosensory, and language functions. In the motor system, unilateral damage to the corticospinal tract can lead to the maintenance of normally-transient ipsilateral corticospinal projections from the contralesional hemisphere. In some patients, this type of corticospinal (re)organization can achieve an active grasp function of the paretic hand, while in others no useful hand function develops although such projections exist. In the somatosensory system, periventricular lesions can be compensated by outgrowing thalamocortical projections forming "bypasses" around the defective white matter to reach the postcentral gyrus. By contrast, lesions in the postcentral gyrus often lead to marked somatosensory deficits. Finally, language functions can be taken over by the right hemisphere in cases of left hemispheric damage, often with excellent functional outcome. Knowledge of these mechanisms is necessary for establishing a "prognostic corridor" of development derived from neuroimaging in newborns with brain lesions.
人类大脑在受到局部损伤后具有优越的重组能力。本综述描述了在产前和围产期获得的单侧大脑损伤后，运动、感觉和语言功能的重组机制。在运动系统中，皮质脊髓束的单侧损伤可导致对侧半球正常短暂的同侧皮质脊髓投射的维持。在一些患者中，这种类型的皮质脊髓（再）组织可以实现瘫痪手的主动抓握功能，而在其他患者中，尽管存在这种投射，但没有有用的手功能发育。在感觉系统中，室周损伤可以通过生长出的丘脑皮质投射形成“旁路”来补偿，绕过有缺陷的白质到达中央后回。相比之下，中央后回的损伤通常会导致明显的感觉缺失。最后，在左半球损伤的情况下，语言功能可以被右半球接管，通常具有出色的功能结果。这些机制的知识对于从有脑损伤的新生儿的神经影像学中建立“发育预后通道”是必要的。
