Kazui S, Kuriyama Y, Sawada T, Imakita S
Department of Medicine, National Cardiovascular Center, Osaka, Japan.
Stroke. 1994 Nov;25(11):2287-9. doi: 10.1161/01.str.25.11.2287.
While magnetic resonance imaging has revealed progressive changes in the pyramidal tract in accordance with histopathologic stages of wallerian degeneration secondary to a supratentorial lesion, computed tomography (CT) has only demonstrated a shrinkage of the pyramidal tract in the midbrain or pons during the chronic stage. We present a patient with frontoparietal subcortical hemorrhage in whom serial CT scans clearly demonstrated wallerian degeneration along the axis of the pyramidal tract early in the acute stage.
A 63-year-old man with a history of hypertension suddenly developed a deterioration of consciousness, transcortical mixed aphasia, and dense hemiplegia on the right side. CT scans revealed a massive intracerebral hematoma in the frontoparietal subcortices of the left hemisphere. Although initial CT did not detect any hypodense areas along the left pyramidal tract below the hematoma, ill-defined areas of decreased density appeared in the posterior limb of the internal capsule, cerebral peduncle of the midbrain, and pontine base of the left side on day 13 after the stroke. These areas became well demarcated on day 22 and persisted thereafter.
An extensive hematoma can interrupt the pyramidal tract fibers that arise not only from the motor cortex and caudal premotor cortex but also from the somatosensory and parietal cortices, allowing very early CT demonstration of wallerian degeneration of the pyramidal tract.
虽然磁共振成像已显示，继发于幕上病变的华勒氏变性的组织病理学阶段与锥体束的进行性变化相符，但计算机断层扫描（CT）仅在慢性期显示中脑或脑桥锥体束萎缩。我们报告一名额顶叶皮质下出血患者，其系列CT扫描在急性期早期就清楚地显示了沿锥体束走行的华勒氏变性。
一名63岁男性，有高血压病史，突然出现意识障碍、经皮质混合性失语和右侧重度偏瘫。CT扫描显示左半球额顶叶皮质下有大量脑内血肿。虽然最初的CT未在血肿下方的左侧锥体束发现任何低密度区，但在卒中后第13天，左侧内囊后肢、中脑大脑脚和脑桥基底部出现了边界不清的密度减低区。这些区域在第22天变得边界清晰，并持续存在。
广泛的血肿可中断不仅起源于运动皮质和尾侧运动前皮质，还起源于躯体感觉皮质和顶叶皮质的锥体束纤维，从而使CT能在很早阶段就显示锥体束的华勒氏变性。
