De Smet Y, Rousseau J J, Brucher J M
Laboratoire de Neuropathologie, UCL, Bruxelles, Belgique.
Rev Neurol (Paris). 1990;146(6-7):415-9.
The first case, to our knowledge, of bilateral, symmetric and simultaneous infarction in the basal territory of the middle cerebral arteries is reported. The patient presented with a pseudo-rostral brainstem syndrome, including loss of oculo-vestibular reflexes, severe tetraparesia and akinetic mutism-like disturbance of consciousness. The lesions were due to embolism, caused by atrial fibrillation, occluding the ostium of the lenticulostriate arteries. It involved only the putamino-capsulo-caudal regions, concerning the whole anterior and posterior dorsal capsules. The term tetraparetic mutism is proposed to describe this new clinico-pathological syndrome, which is the sum of a capsular tetraparesia, due to the lesion of the geniculate and cortico-spinal fibres at the level of the genu and posterior limbs, and of a capsular akinetic mutism, due to the lesion of the reticular thalamo-cortical tracts at the level of the anterior limbs. These total capsular infarcts moreover involved all the oculomotor cortico-reticular tracts, which could explain the absence of oculo-vestibular reflexes.
据我们所知，首次报道了双侧、对称且同时发生的大脑中动脉基底节区梗死病例。该患者表现为假性延髓综合征，包括眼前庭反射消失、严重四肢瘫以及类似运动不能性缄默的意识障碍。病变是由心房颤动引起的栓塞导致豆纹动脉开口闭塞所致。病变仅累及壳核 - 内囊 - 尾状核区域，涉及整个前、后背侧内囊。本文提出“四肢瘫性缄默”这一术语来描述这种新的临床病理综合征，它是由于在膝部和后肢水平的膝状体和皮质脊髓纤维受损导致的内囊四肢瘫，以及在前肢水平的网状丘脑皮质束受损导致的内囊运动不能性缄默的总和。此外，这些完全性内囊梗死累及了所有动眼神经皮质网状束，这可以解释眼前庭反射消失的原因。
