Fries W, Danek A, Scheidtmann K, Hamburger C
Neurologische Klinik, Ludwig-Maximilians-Universität, München, Germany.
Brain. 1993 Apr;116 ( Pt 2):369-82. doi: 10.1093/brain/116.2.369.
The functional anatomy of motor recovery was studied by assessing motor function quantitatively in 23 patients following capsular or striatocapsular stroke. While selective basal ganglia lesions (caudate and/or putamen exclusively) did not affect voluntary movements of the extremities, lesions of the anterior (plus caudate/putamen) or posterior limb of the internal capsule led to an initially severe motor impairment followed by excellent recovery, hand function included. In contrast, lesions of the posterior limb of the internal capsule in combination with damage to lateral thalamus compromised motor outcome. In experimental tracing of the topography of the internal capsule in macaque monkeys, we found axons of primary motor cortex passing through the middle third of the posterior limb of the internal capsule. Axons of premotor cortex (dorsolateral and post-arcuate area 6) passed through the capsular genu, and those of supplementary motor area (mesial area 6) through the anterior limb. Small capsular lesion can therefore disrupt the output of functionally and anatomically distinct motor areas selectively. The clinically similar motor deficits with a similar course of functional restitution following disruption of these different descending motor pathways indicate a parallel operation of cortical motor areas. They may have the further capability of substituting each other functionally in the process of recovery from hemiparesis.
通过对23例壳核或纹状体-壳核卒中患者的运动功能进行定量评估，研究了运动恢复的功能解剖学。虽然选择性基底神经节病变（仅尾状核和/或壳核）不影响肢体的自主运动，但内囊前肢（加尾状核/壳核）或后肢病变会导致最初严重的运动障碍，随后恢复良好，包括手部功能。相比之下，内囊后肢病变合并外侧丘脑损伤会损害运动结果。在猕猴内囊地形图的实验追踪中，我们发现初级运动皮层的轴突穿过内囊后肢的中三分之一。运动前皮层（背外侧和弓状后区6）的轴突穿过内囊膝部，辅助运动区（内侧区6）的轴突穿过内囊前肢。因此，小的内囊病变可选择性地破坏功能和解剖学上不同的运动区的输出。这些不同下行运动通路中断后临床上相似的运动缺陷以及相似的功能恢复过程表明皮质运动区存在并行运作。它们在偏瘫恢复过程中可能还具有功能上相互替代的能力。
