Bhatia K P, Marsden C D
University Department of Clinical Neurology, Institute of Neurology, London, UK.
Brain. 1994 Aug;117 ( Pt 4):859-76. doi: 10.1093/brain/117.4.859.
The behavioural and movement disorders reported in 240 patients described in the literature with lesions affecting the caudate nucleus, putamen and the globus pallidus (lentiform nucleus) have been analysed. Reports were classified into two groups: small or isolated lesions involving the said nuclei alone; and large lesions with additional involvement of the adjacent internal capsule and/or periventricular white matter. Amongst the 240 cases, dystonia was the most frequent movement disorder recorded (36%); chorea (8%) and parkinsonism (6%) or dystonia-parkinsonism (3%) were uncommon. The commonest behavioural disturbance was the syndrome of abulia (apathy with loss of initiative and of spontaneous thought and emotional responses) (13%); disinhibition was rare (4%). Confusion usually was associated with intracerebral haemorrhage and depression was a relatively non-specific finding. Aphasia was extremely rare with lesions confined to these basal ganglia structures. Lesions of the caudate nucleus rarely caused motor disorders but were more likely to cause behavioural problems. Chorea has been described in only 6% of those with caudate lesions, and dystonia in only 9%. The most significant behavioural disturbance described in 28% of those with caudate lesions was the syndrome of abulia, sometimes alternating with disinhibition (11%). Lesions of the lentiform nuclei rarely caused abulia (10%) and did not produce disinhibition, but they commonly caused dystonia (49%), particularly when the putamen was involved (63%). Bilateral lesions of the lentiform nuclei, either of the globus pallidus or of the putamen, caused parkinsonism (19%) or dystonia-parkinsonism (6%) infrequently. The prominence of the behavioural disturbance of abulia with caudate lesions emphasizes the more complex cognitive role of this basal ganglia structure. The frequent occurrence of dystonia and less commonly of parkinsonism with lentiform lesions emphasize the motor roles of putamen and globus pallidus.
对文献中描述的240例尾状核、壳核和苍白球（豆状核）受损患者所报告的行为和运动障碍进行了分析。报告分为两组：仅涉及上述核团的小病灶或孤立病灶；以及累及相邻内囊和/或脑室周围白质的大病灶。在这240例病例中，肌张力障碍是记录到的最常见运动障碍（36%）；舞蹈症（8%）、帕金森症（6%）或肌张力障碍 - 帕金森症（3%）并不常见。最常见的行为障碍是意志缺失综合征（冷漠，缺乏主动性、自发思维和情感反应）（13%）；去抑制现象罕见（4%）。意识模糊通常与脑出血有关，抑郁是相对非特异性的表现。局限于这些基底节结构的病灶极少导致失语症。尾状核病变很少引起运动障碍，但更易导致行为问题。尾状核病变患者中仅有6%出现舞蹈症，9%出现肌张力障碍。尾状核病变患者中有28%出现的最显著行为障碍是意志缺失综合征，有时与去抑制现象交替出现（11%）。豆状核病变很少导致意志缺失（10%），也不会产生去抑制现象，但常导致肌张力障碍（49%），尤其是累及壳核时（63%）。苍白球或壳核的双侧豆状核病变很少导致帕金森症（19%）或肌张力障碍 - 帕金森症（6%）。尾状核病变时意志缺失行为障碍的突出表现强调了该基底节结构更复杂的认知作用。豆状核病变时肌张力障碍频繁出现，帕金森症较少见，这强调了壳核和苍白球的运动作用。
