Uncini A, Caporale C M, Caulo M, Ferretti A, Tartaro A, Ranieri F, Di Lazzaro V
Department of Oncology and Neurosciences, "G. d'Annunzio" University and the Aging Research Center, Ce.SI, "G. d'Annunzio" University Foundation, Chieti-Pescara, Italy.
BMJ Case Rep. 2009;2009. doi: 10.1136/bcr.07.2008.0532. Epub 2009 Jan 23.
The corticospinal tract influences the distal musculature more than the proximal, and the mechanisms involved in recovery of proximal muscle strength after stroke are unclear. A 65 year old man developed right shoulder weakness due to infarction in the left precentral gyrus. MRI showed a 3 mm cortical-subcortical ischaemic lesion in the superior genu of the left precentral gyrus medially to the knob-like structure corresponding to the motor area of the hand. Two months after stroke, when the patient was able to abduct the right arm against gravity and seven months after stroke when the patient had almost completely recovered, maximal TMS of the contralateral and ipsilateral motor cortex during voluntary contraction did not evoke a MEP in the right deltoid either with a focal or a non-focal coil. Recovery of proximal muscles in these cases may be mediated by elements other than the fast corticospinal neurones responsible for MEP generation.
皮质脊髓束对远端肌肉组织的影响大于近端，而中风后近端肌肉力量恢复所涉及的机制尚不清楚。一名65岁男性因左侧中央前回梗死出现右肩无力。MRI显示，在对应于手部运动区的旋钮状结构内侧，左侧中央前回上膝部有一个3毫米的皮质-皮质下缺血性病变。中风后两个月，患者能够在抗重力的情况下外展右臂；中风后七个月，患者几乎完全康复。在自愿收缩过程中，使用聚焦或非聚焦线圈对健侧和患侧运动皮层进行最大程度的经颅磁刺激（TMS），均未在右侧三角肌诱发出运动诱发电位（MEP）。在这些病例中，近端肌肉的恢复可能由负责MEP产生的快速皮质脊髓神经元以外的其他因素介导。
