Morimatsu M, Negoro K
Department of Neurology, Yamaguchi University School of Medicine.
Rinsho Shinkeigaku. 1995 Dec;35(12):1459-62.
Eight cases of clinically diagnosed corticobasal degeneration (CBD) were studied with reference to their symptomatology, brain-imagings and electrophysiological findings. The diagnosis was based on the combination of limb-kinetic apraxia (cortical sign), akinetic-rigid sign (extrapyramidal) and their unilateral predominance. Magnetic resonance imaging (MRI) and 123I-IMP or 99mTc-HMPAO SPECT findings were used to reinforce the diagnosis. The age at onset of 8 cases (4 males, 4 females) was 61 to 80 years (mean 66). Other common symptoms on admission consisted of dysequilibrium (8 cases), dysarthria (8), grasp reflex (6), supranuclear gaze palsy (6), tremor (6), limb dystonia (6) and alien limbs (5). MRI revealed parietal (3 cases) or frontoparietal (3) atrophy. SPECT showed decrease in cerebral blood flow in frontoparietal (3 cases) or frontoparietotemporal lobes (5). SPECT surpassed MRI to detect unilateral predominance of the lesions. With magnetic stimulation of the head and neck central motor conduction time (CMCT) was normal, while motor inhibitory periods (IPs) were significantly shorter in CBD patients compared with those in normal controls and the patients with Parkinson's disease. In 3 patients with reflex myoclonus, giant SEPs were not evoked, though with positive C-reflex, suggesting an elevated excitability of cerebral cortex unrelated to the production of giant SEPs.
对8例临床诊断为皮质基底节变性(CBD)的患者进行了研究,分析了其症状、脑成像和电生理检查结果。诊断依据肢体运动性失用(皮质征)、运动不能-强直征(锥体外系征)及其单侧优势的组合。采用磁共振成像(MRI)以及123I-异丁基安非他明(IMP)或99m锝-六甲基丙二胺肟(HMPAO)单光子发射计算机断层扫描(SPECT)结果来强化诊断。8例患者(4男4女)的发病年龄为61至80岁(平均66岁)。入院时的其他常见症状包括平衡障碍(8例)、构音障碍(8例)、抓握反射(6例)、核上性凝视麻痹(6例)、震颤(6例)、肢体肌张力障碍(6例)和异己肢体现象(5例)。MRI显示顶叶萎缩(3例)或额顶叶萎缩(3例)。SPECT显示额顶叶(3例)或额顶颞叶(5例)脑血流量减少。SPECT在检测病变的单侧优势方面优于MRI。对头颈部进行磁刺激时,皮质运动中枢传导时间(CMCT)正常,但与正常对照组和帕金森病患者相比,CBD患者的运动抑制期(IPs)明显缩短。3例有反射性肌阵挛的患者未引出巨大体感诱发电位(SEPs),尽管C反射阳性,提示大脑皮质兴奋性升高与巨大SEPs的产生无关。