一名患有霍姆斯震颤和腭部震颤患者的丘脑腹中间核毁损术——病理生理学思考
Vim thalamotomy in a patient with Holmes' tremor and palatal tremor - Pathophysiological considerations.
作者信息
Maki Futaba, Sato Sumito, Watanabe Katsushige, Yanagisawa Toshiyuki, Hagiwara Yuta, Shimizu Takahiro, Hasegawa Yasuhiro
机构信息
Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, 216-8511, Japan.
Department of Neurosurgery, Kitasato University School of Medicine, Kanagawa, Japan.
出版信息
BMC Neurol. 2015 Mar 11;15:26. doi: 10.1186/s12883-015-0277-5.
BACKGROUND
We peformed a ventral intermediate nucleus (Vim) thalamotomy in a patient with Holmes' tremor and palatal tremor. The frequencies of these movement disorders were 4 Hz and 3 Hz, respectively. Vim thalamotomy stopped the Holmes' tremor but not the palatal tremor. Our observations suggest different mechanisms for these two involuntary movements.
CASE PRESENTATION
A 57-arm 11 months after a pontine hemorrhage. Transoral carotid ultrasonography revealed periodic motion of her posterior pharyngeal wall with a frequency of 3 Hz. Recording of neuronal activities in the thalamus revealed a 4Hz rhythmic discharge time that was associated with her tremor in the contralateral arm. A left Vim thalamotomy was performed. The resting tremor of the upper limb stopped, but the kinetic tremor recurred 6 months after the thalamotomy. No effect was observed on her palatal tremor.
CONCLUSIONS
The different effects of Vim thalamotomy on the Holmes' tremor and palatal tremor suggest different oscillation sources for these two involuntary movements.
背景
我们对一名患有霍姆斯震颤和腭部震颤的患者进行了腹中间核（Vim）丘脑切开术。这些运动障碍的频率分别为4赫兹和3赫兹。Vim丘脑切开术消除了霍姆斯震颤，但未能消除腭部震颤。我们的观察结果提示这两种不自主运动存在不同的机制。
病例报告
一名57岁女性，在脑桥出血11个月后出现症状。经口颈动脉超声检查显示其咽后壁有频率为3赫兹的周期性运动。丘脑神经元活动记录显示，与对侧手臂震颤相关的有一个4赫兹的节律性放电时间。进行了左侧Vim丘脑切开术。上肢的静止性震颤停止，但在丘脑切开术后6个月又出现了动作性震颤。对其腭部震颤未观察到效果。
结论
Vim丘脑切开术对霍姆斯震颤和腭部震颤的不同影响提示这两种不自主运动有不同的振荡源。
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