Loeb C, Gandolfo C, Caponnetto C, Del Sette M
Department of Neurology, University of Genova, Italy.
Eur Neurol. 1990;30(1):42-6. doi: 10.1159/000116638.
61 of 1,590 (3.8%) patients with cerebrovascular disease showed suprabulbar palsy of the pure form (42 patients; 2 had autopsy) and striate form (19 patients; 3 had autopsy). 25 patients with the pallidopyramidal syndrome were included since the clinical picture bordered on the striate form. The pure variety was characterized by dysarthria, dysphagia and automatic voluntary dissociation of facial movements. Half of the patients also had hemiparesis, primitive reflexes and short-step gait. In the striate form, the main signs were dysarthria, dysphagia, automatic voluntary dissociation, rigidity and hypokinesia. Brisk tendon reflexes, primitive reflexes, short-step gait and mental deterioration were also present in half of the patients. The pure variety was caused by multiple infarcts and/or lacunae (85.7%), while the striate form had vascular lesions by computed tomography in only 36.8% of the cases. Histological findings, showing lipohyalinosis of the arterial wall leading to stenosis and occlusion of the lumen and tissue rarefaction and disintegration, support the assumption that microinfarctions, sometimes found only by histopathological examination, are the leading pathogenetic factor in this form. Hypertension, cardiopathy, smoking habit, dyslipemia and diabetes are the most frequent risk factors in both forms.
1590例脑血管疾病患者中有61例（3.8%）表现为单纯型（42例；2例尸检）和纹状体型（19例；3例尸检）的脑桥以上麻痹。25例苍白球-锥体束综合征患者被纳入研究，因为其临床表现与纹状体型相近。单纯型的特征为构音障碍、吞咽困难以及面部运动的随意与不随意分离。半数患者还伴有偏瘫、原始反射和短步幅步态。在纹状体型中，主要体征为构音障碍、吞咽困难、随意与不随意分离、强直和运动迟缓。半数患者还存在腱反射亢进、原始反射、短步幅步态和智力减退。单纯型由多发性梗死和/或腔隙性梗死引起（85.7%），而纹状体型仅36.8%的病例通过计算机断层扫描显示有血管病变。组织学检查发现动脉壁脂质透明变性导致管腔狭窄和闭塞以及组织稀疏和崩解，支持了以下假设，即有时仅通过组织病理学检查才能发现的微梗死是这种类型的主要致病因素。高血压、心脏病、吸烟习惯、血脂异常和糖尿病是两种类型中最常见的危险因素。
