Department of Neurology, Teikyo University School of Medicine, Kaga 2-11-1, Itabashi-ku, Tokyo, 1738605, Japan.
BMC Neurol. 2021 May 31;21(1):214. doi: 10.1186/s12883-021-02247-z.
The course of the corticobulbar tract (CBT) to the facial nucleus has been investigated by some previous studies. However, there are some unclear points of the course of the CBT to the facial nucleus. This study aimed to elucidate the detailed course of the CBT to the facial nucleus through the analysis of lateral medullary infarction (LMI) cases.
The neurological characteristics and magnetic resonance imaging findings of 33 consecutive patients with LMI were evaluated. The location of the lesions was classified rostro-caudally (upper, middle, or lower) and horizontally. Further, we compared the neurological characteristics between the groups with and without central facial paresis (FP).
Eight (24%) patients with central FP ipsilateral to the lesion were identified. Dysphagia and hiccups were more frequently observed in the group with central FP than in the group without central FP. In patients with central FP, middle medullary lesions and those including the ventral part of the dorsolateral medulla were more frequently observed. Contrastingly, patients with lesions restricted to the lateral and dorsal regions of the dorsolateral medulla did not present with central FP.
The results of this study indicate that the CBT to the facial nucleus descends with the corticospinal tract at least to the middle portion of the medulla, and then ascends to the facial nucleus through the medial and ventral areas of the dorsolateral medulla after decussation.
一些先前的研究已经调查了皮质延髓束（CBT）到面核的行程。然而，CBT 到面核的行程仍存在一些不清楚的地方。本研究旨在通过分析外侧延髓梗死（LMI）病例阐明 CBT 到面核的详细行程。
评估了 33 例连续 LMI 患者的神经特征和磁共振成像发现。病变的位置按头侧-尾侧（上、中、下）和水平方向分类。此外，我们比较了有和无中央面肌无力（FP）的两组之间的神经特征。
确定了 8 例（24%）病变同侧中央 FP 的患者。有中央 FP 的组比无中央 FP 的组更常出现吞咽困难和呃逆。在有中央 FP 的患者中，更常观察到中脑病变和包括背外侧延髓腹侧部分的病变。相比之下，病变仅限于背外侧延髓的外侧和背侧区域的患者没有出现中央 FP。
本研究结果表明，CBT 与皮质脊髓束一起至少下降到延髓中部，然后在交叉后通过背外侧延髓的内侧和腹侧区域上升到面核。
