Masdeu J C, Gorelick P B
Department of Neurology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY.
Ann Neurol. 1988 Jun;23(6):596-603. doi: 10.1002/ana.410230612.
Inability to stand in the absence of motor weakness or marked sensory loss is usually considered to reflect midline cerebellar disease. However, the 15 patients reported here had astasia related to unilateral thalamic lesions, documented by autopsy and computed tomography in 2 patients and by computed tomography in 13. The lesions, including infarction (6), hemorrhage (7), and tumor (2), involved primarily the superoposterolateral portion of the thalamus, but spared the rubral region. Alert, with normal or near-normal strength on isometric muscle testing and a variable degree of sensory loss, the patients could not stand and 7 of them could not sit up unassisted. They fell backwards or toward the side contralateral to the lesion. They appeared to have a deficit of overlearned motor activity of an axial and postural nature. In the vascular cases, the deficit improved in a few days or weeks. However, these patients had a tendency to sustain falls during the rehabilitation period.
在没有运动无力或明显感觉丧失的情况下无法站立，通常被认为反映了中线小脑疾病。然而，本文报告的15例患者存在与单侧丘脑病变相关的起立不能，2例经尸检和计算机断层扫描证实，13例经计算机断层扫描证实。病变包括梗死（6例）、出血（7例）和肿瘤（2例），主要累及丘脑的上后外侧部分，但红核区域未受累。患者神志清醒，等长肌力测试时力量正常或接近正常，感觉丧失程度不一，无法站立，其中7例无法自主坐起。他们向后或向病变对侧跌倒。他们似乎缺乏一种过度学习的轴向和姿势性运动活动。在血管性病例中，这种缺陷在几天或几周内有所改善。然而，这些患者在康复期间有持续跌倒的倾向。
