Takahashi S, Satoh N, Takahashi H, Chiba K, Tohgi H
Department of Neurology, Iwate Medical University.
Rinsho Shinkeigaku. 1995 Apr;35(4):352-7.
We compared locations of infarctions and clinical characteristics for patients with dysarthria and those without dysarthria. Subjects were 40 patients with a small infarction in the corona radiata or junctional zone to the capsule and 13 patients with infarctions in the internal capsule. Left corona radiata/junctional zone infarctions were significantly smaller than right sided lesions. Dysarthria was associated more frequently with the corona/junctional lesions on the left side than the right sided lesions. Asymptomatic infarctions on the contralateral side were seen in 41% of the patients with dysarthria. In these cases, dysarthria continued longer and dysphagia occurred more frequently than the cases without right sided lesions. Corona radiata/junctional zone infarctions with dysarthria were located significantly more anteriorly than those without dysarthria. The corona radiata/junctional zone infarctions presenting with dysarthria alone, upper limb dominant hemiparesis, and lower dominant hemiparesis were located in the anterior, middle, and posterior areas, respectively. In conclusion, dysarthria may occur with unilateral small cerebral infarctions, more frequently with left sided lesions than with right sided lesions. It is assumed that the left corona radiata/junctional zone infarction may interrupt simultaneously the corticobulbar pathway and callosal fibers to the right hemisphere which transmit motor information for speech to the right hemisphere. It is also possible that there are individual variations in the proportion of crossed and uncrossed corticobulbar innervation, which may explain dysarthria with unilateral cerebral lesions in some patients. It was suggested that there is an anterior-posterior somatotopy in the corona radiata/junctional zone as well as in the internal capsule.
我们比较了构音障碍患者和无构音障碍患者的梗死部位及临床特征。研究对象为40例在放射冠或放射冠与内囊交界处有小梗死灶的患者以及13例在内囊有梗死灶的患者。左侧放射冠/交界区梗死灶明显小于右侧病变。构音障碍与左侧放射冠/交界区病变的关联比右侧病变更为频繁。41%有构音障碍的患者在对侧有无症状性梗死灶。在这些病例中，与无右侧病变的病例相比，构音障碍持续时间更长，吞咽困难发生频率更高。伴有构音障碍的放射冠/交界区梗死灶位置明显比无构音障碍的梗死灶更靠前。仅表现为构音障碍、上肢为主的偏瘫和下肢为主的偏瘫的放射冠/交界区梗死灶分别位于前部、中部和后部区域。总之，单侧小的脑梗死可能会出现构音障碍，左侧病变比右侧病变更易出现。据推测，左侧放射冠/交界区梗死可能同时中断了皮质延髓通路和连接至右半球的胼胝体纤维，这些纤维将言语运动信息传递至右半球。也有可能是皮质延髓交叉和不交叉神经支配的比例存在个体差异，这可能解释了部分患者单侧脑损伤时出现构音障碍的原因。研究表明，放射冠/交界区以及内囊存在前后躯体定位关系。
