Lechevalier B, Bertran F, Busson P, Chapon F, Raoul G, De La Sayette V
Service de Neurologie Dejerine et Laboratoire de Neuropathologie, CHU de Caen, France.
Rev Neurol (Paris). 1996 Mar;152(3):181-9.
A 65 years old woman with chronic high blood pressure and diabetes mellitus presented with a mutism akinetic of sudden onset and a right total hemiplegia with a Babinski sign secondary to a left anterior cerebral artery infarction. She had had six months earlier a transient gait disturbance. At that time, the CT scan showed lacunar infarcts of the head of both caudate nuclei. Neuropathological examination revealed that the left infarction of the anterior cerebral artery involved the superior frontal gyrus, the supplementary motor area, the cingulate gyrus and the corpus callosum. There were also multiple lacunes of the head of both caudate nuclei, anterior limb of the internal capsules, white matter, basal ganglia and thalami. The mutism akinetic was thought to be the result of a bilateral disruption of a functional loop including on each side, the supplementary motor area, the cingulate gyrus, the subcallosal tract and the head of the caudate nucleus. On the right side, the lesion of the caudate nucleus could have interrupted this loop normally involved in the induction of voluntary movements and in the communication with the external surroundings.
一名65岁患有慢性高血压和糖尿病的女性，突发缄默、运动不能，并伴有右侧完全性偏瘫及巴宾斯基征，继发于左侧大脑前动脉梗死。6个月前她曾出现短暂性步态障碍。当时，CT扫描显示双侧尾状核头部有腔隙性梗死。神经病理学检查发现，左侧大脑前动脉梗死累及额上回、辅助运动区、扣带回和胼胝体。双侧尾状核头部、内囊前肢、白质、基底神经节和丘脑也有多个腔隙。缄默、运动不能被认为是一个功能环路双侧中断的结果，该环路在每一侧包括辅助运动区、扣带回、胼胝体下束和尾状核头部。在右侧，尾状核的病变可能中断了这个通常参与自发运动诱导和与外界交流的环路。
