Courchesne E
Neurosciences Department, School of Medicine, University of California, San Diego, La Jolla.
Pediatrics. 1991 May;87(5 Pt 2):781-90.
Based on neuroimaging and autopsy research, in autism no common site or type of abnormality appears in the cerebral hemispheres, thalamus, lenticular nuclei, and caudate nucleus. Nonetheless, further imaging and autopsy studies on this issue can be anticipated. Limbic system abnormalities have been reported at autopsy by one laboratory but not another, and no abnormality was found by the one quantitative MR study to measure a limbic structure. More autopsy and imaging research on the limbic system is needed. The cerebellum is the only anatomical structure for which there is both imaging and autopsy evidence of abnormality based on data gathered by many laboratories. Also, the only autopsy study to conduct statistical analyses of cerebellar cell loss found statistically significant Purkinje cell loss in both the vermis and hemispheres. Despite this, normal findings on routine radiologic examination are not of diagnostic significance at this time. On the one hand, the autopsy data show that most, if not all, autistic individuals have cerebellar cell loss, but on the other, research shows that MR images of the cerebellum in a substantial proportion of autistic individuals (perhaps 20% to 50%) will be indistinguishable from normal. Thus, it is likely that MR technology is not yet sufficiently sensitive to detect cerebellar abnormalities in all autistic persons who have them. Finally, the cerebellum seems an unlikely site of damage for a developmental disorder of higher cognition such as autism. However, new neurophysiologic and neuropsychologic studies of children with hemicerebellar resections and children with hemicerebellar resections and children with autism present an entirely new picture of the role of the cerebellum in normal human cognition in general and in the development of the social and communication deficits in autism in particular. These studies show that autistic subjects and patients with acquired cerebellar damage are unable to rapidly shift their mental focus of attention.
基于神经影像学和尸检研究，在自闭症患者中，大脑半球、丘脑、豆状核和尾状核未出现常见的异常部位或异常类型。尽管如此，可以预期会有更多关于此问题的影像学和尸检研究。一个实验室在尸检中报告了边缘系统异常，而另一个实验室未报告，并且一项测量边缘结构的定量磁共振研究未发现异常。因此，需要对边缘系统进行更多的尸检和影像学研究。小脑是唯一一个有多个实验室收集的数据表明存在影像学和尸检异常证据的解剖结构。此外，唯一一项对小脑细胞损失进行统计分析的尸检研究发现，蚓部和半球的浦肯野细胞损失具有统计学意义。尽管如此，目前常规放射学检查的正常结果并无诊断意义。一方面，尸检数据表明，大多数（如果不是全部）自闭症个体存在小脑细胞损失，但另一方面，研究表明，相当一部分自闭症个体（可能20%至50%）的小脑磁共振图像与正常图像无法区分。因此，磁共振技术可能尚未足够灵敏，无法检测出所有存在小脑异常的自闭症患者。最后，对于像自闭症这样的高级认知发育障碍来说，小脑似乎不太可能是损伤部位。然而，对患有半侧小脑切除术的儿童以及患有半侧小脑切除术的儿童和自闭症儿童进行的新的神经生理学和神经心理学研究，为小脑在一般人类正常认知中，特别是在自闭症社交和沟通缺陷发展中的作用，呈现了一幅全新的图景。这些研究表明，自闭症患者和后天小脑损伤患者无法迅速转移其精神注意力焦点。
