Chen Ko-Ting, Huang Sheng-Yao, Chen Yi-Jye, Chen Ying-Yun
Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan.
Neuroscience Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan.
Brain Sci. 2023 Sep 26;13(10):1371. doi: 10.3390/brainsci13101371.
Astasia refers to the inability to maintain upright posture during standing, despite having full motor strength. Impairment of the vestibulocerebellar pathway, graviceptive system, and cingulate motor area have been proposed to be related to astasia. However, the responsible neural pathways remain unclear. We hypothesize that there is a common neural network behind astasia. To test the hypothesis, we reviewed all reported cases with astasia, including ours, and focused on the correlation between anatomical destruction and symptom presentation. A total of 26, including ours, non-psychogenic astasia patients were identified in the English literature. Seventy-three percent of them were associated with other neurologic symptoms and sixty-two percent of reported lesions were on the right side. Contralateral lateropulsion was very common, followed by retropulsion, when describing astasia. Infarction (54%) was the most reported cause. The thalamus (65%) was the most reported location. Infarctions were the fastest to recover (mean: 10.6 days), while lesions at the brainstem needed a longer time (mean: 61.6 days). By combining the character of lateropulsion in astasia and the presentation of an interrupted graviceptive system, we concluded that the primary graviceptive system may be the common neural network behind astasia. Future studies on astasia should focus on the pathological changes in the perception of verticality in the visual world and the body.
站立不能指的是尽管具备完全的运动力量，但在站立时无法维持直立姿势。前庭小脑通路、重力感知系统和扣带回运动区的损伤被认为与站立不能有关。然而，相关的神经通路仍不明确。我们推测站立不能背后存在一个共同的神经网络。为了验证这一推测，我们回顾了所有已报道的站立不能病例，包括我们自己的病例，并着重关注解剖结构破坏与症状表现之间的相关性。在英文文献中总共确定了26例（包括我们的病例）非心因性站立不能患者。其中73%与其他神经症状相关，62%的报告病变位于右侧。描述站立不能时，对侧侧推非常常见，其次是后推。梗死（54%）是最常报道的病因。丘脑（65%）是最常报道的病变部位。梗死恢复最快（平均：10.6天），而脑干病变恢复所需时间更长（平均：61.6天）。通过结合站立不能时侧推的特点以及重力感知系统中断的表现，我们得出结论，初级重力感知系统可能是站立不能背后的共同神经网络。未来关于站立不能的研究应聚焦于视觉世界和身体中垂直感知的病理变化。
