Krauss J K, Wakhloo A K, Nobbe F, Tränkle R, Mundinger F, Seeger W
Department of Neurosurgery, Albert-Ludwigs-Universität, Freiburg, Germany.
Neurol Res. 1995 Dec;17(6):409-16.
The present study investigates evidence of dentatothalamic pathway lesions in nineteen patients with severe kinetic post-traumatic tremor respectively by magnetic resonance imaging (MRI). Kinetic tremor is thought to be characteristic of lesions of the cerebellar outflow. While this hypothesis is supported by experimental data, neuropathological and neuroradiological findings have been limited. The appendicular tremors were unilateral in 13 patients and bilateral in 6, accounting for 25 instances of tremor. The tremor developed after severe head trauma in 18 patients. These patients had evidence of diffuse axonal injury on MRI. Postural and kinetic tremor was present in all patients, and was accompanied by tremor also present at rest in 14 instances. Multiplanar MRI studies were performed on a high-field MRI system operating at 2.0 T in 13 patients and on intermediate-field strength MRI systems in 6 patients according to a standardized protocol. To detect small deposits of hemosiderin after post-traumatic lesions, the protocol included a heavily T2-weighted spin-echo pulse sequence. Lesions of the dentatothalamic pathways were found in 22 instances. The lesions were classified into different types of according to their distribution. A lesion of the dentate nucleus ipsilateral to the tremor (type 1) was found in one instance (4%), lesions involving the ipsilateral predecussational dentatothalamic pathway (type II and III) were found in 14 instances (56%), and lesions involving the contralateral post-decussational course (type IV) in 7 instances (28%). One patient with a mild head trauma had a lesion of the contralateral thalamus. The lesions appeared as hypointense, hyperintense or mixed. Two of three patients with a parkinsonian-like rest tremor had type IV lesions involving the substantia nigra. The nosological concepts of tremors are discussed. 'Midbrain' tremor may have distinct pathoanatomical lesion sites.
本研究通过磁共振成像（MRI）分别调查了19例严重创伤后运动性震颤患者齿状丘脑通路病变的证据。运动性震颤被认为是小脑传出通路病变的特征。虽然这一假说得到了实验数据的支持，但神经病理学和神经放射学的研究结果有限。13例患者的肢体震颤为单侧，6例为双侧，共25例震颤。18例患者的震颤发生在严重头部外伤后。这些患者在MRI上有弥漫性轴索损伤的证据。所有患者均存在姿势性和运动性震颤，其中14例还伴有静止性震颤。13例患者在2.0T的高场MRI系统上按照标准化方案进行了多平面MRI研究，6例患者在中场强MRI系统上进行了研究。为了检测创伤后病变后的小量含铁血黄素沉积，方案中包括了重T2加权自旋回波脉冲序列。发现22例齿状丘脑通路病变。根据病变分布将其分为不同类型。震颤同侧齿状核病变（1型）1例（4%），累及同侧交叉前齿状丘脑通路的病变（2型和3型）14例（56%），累及对侧交叉后行程的病变（4型）7例（28%）。1例轻度头部外伤患者对侧丘脑有病变。病变表现为低信号、高信号或混合信号。3例帕金森样静止性震颤患者中有2例有累及黑质的4型病变。讨论了震颤的疾病分类概念。“中脑”震颤可能有不同的病理解剖病变部位。
