Carrasco-Moro R, Martínez-San Millán J S, Pascual J M
Department of Neurosurgery, Ramón y Cajal U, Comenar Rd., Km. 9.100, Madrid, Spain.
Department of Neuroradiology, Ramón y Cajal U. H, Madrid, Spain.
Rev Neurol (Paris). 2023 Oct;179(8):844-865. doi: 10.1016/j.neurol.2022.11.015. Epub 2023 Mar 10.
This works comprehensively analyses a modern cohort of patients with ipsilateral hemiparesis (IH) and discusses the pathophysiological theories elaborated to explain this paradoxical neurological sign according to the findings from contemporary neuroimaging and neurophysiological techniques.
A descriptive analysis of the epidemiological, clinical, neuroradiological, neurophysiological, and outcome data in a series of 102 case reports of IH published on since the introduction of CT/MRI diagnostic methods (years 1977-2021) was performed.
IH mostly developed acutely (75.8%) after traumatic brain injury (50%), as a consequence of the encephalic distortions exerted by an intracranial haemorrhage eventually causing contralateral peduncle compression. Sixty-one patients developed a structural lesion involving the contralateral cerebral peduncle (SLCP) demonstrated by modern imaging tools. This SLCP showed certain variability in its morphology and topography, but it seems pathologically consistent with the lesion originally described in 1929 by Kernohan & Woltman. The study of motor evoked potentials was seldom employed for the diagnosis of IH. Most patients underwent surgical decompression, and a 69.1% experienced some improvement of the motor deficit.
Modern diagnostic methods support that most cases in the present series developed IH following the KWNP model. The SLCP is presumably the consequence of either compression or contusion of the cerebral peduncle against the tentorial border, although focal arterial ischemia may also play a contributing role. Some improvement of the motor deficit should be expected even in the presence of a SLCP, provided the axons of the CST were not completely severed.
本研究全面分析了一组现代同侧偏瘫（IH）患者，并根据当代神经影像学和神经生理学技术的研究结果，讨论了为解释这一矛盾的神经学体征而阐述的病理生理理论。
对自CT/MRI诊断方法引入以来（1977 - 2021年）发表的102例IH病例报告中的流行病学、临床、神经放射学、神经生理学和结局数据进行描述性分析。
IH大多在创伤性脑损伤（50%）后急性发生（75.8%），这是由于颅内出血引起的脑扭曲最终导致对侧脑桥受压所致。61例患者经现代影像学工具证实存在涉及对侧脑桥的结构性病变（SLCP）。该SLCP在形态和位置上表现出一定的变异性，但在病理上似乎与1929年Kernohan和Woltman最初描述的病变一致。运动诱发电位研究很少用于IH的诊断。大多数患者接受了手术减压，69.1%的患者运动功能缺损有一定改善。
现代诊断方法支持本系列中的大多数病例遵循KWNP模型发生IH。SLCP可能是脑桥在小脑幕边缘受压或挫伤的结果，尽管局灶性动脉缺血也可能起一定作用。即使存在SLCP，只要皮质脊髓束的轴突没有完全切断，运动功能缺损仍有望得到一定改善。
