Braak H, Braak E, Yilmazer D, Schultz C, de Vos R A, Jansen E N
Department of Anatomy, J. W. Goethe Universität, Frankfurt/Main, Federal Republic of Germany.
J Neural Transm Suppl. 1995;46:15-31.
This article reviews data on the internal organization, neuronal types, and interconnections of limbic and motor components of the human brain, and the specific lesions which a few of them undergo during the course of Parkinson's disease (neuronal loss associated with the development of Lewy bodies and Lewy neurites). The severe involvement of nigral neuromelanin-laden projection cells has received particular attention during the past decades. This lesion interferes with normal function of the striatum and probably contributes to many of the motor dysfunctions characteristically occurring in Parkinson's disease. The similarly severe involvement of several areas and nuclei outside of the substantia nigra has often escaped notice. However, the pathology of Parkinson's disease cannot be completely described unless changes in these extranigral areas are taken into account. Interpretation of the characteristic lesional pattern is facilitated by combining schemata of both the limbic and motor systems. This approach reveals a key role by the amygdala and related structures in extranigral pathology. Severe lesions occur in the central amygdaloid nucleus, in nuclei projecting to the cerebral cortex in a non-specific manner, and in nuclei regulating endocrine and autonomic functions. It is suggested that extranigral lesions contribute to the development of behavioral changes and autonomic dysfunction.
本文回顾了有关人类大脑边缘系统和运动系统的内部组织、神经元类型以及它们之间的相互连接的数据，以及其中一些结构在帕金森病过程中所经历的特定病变（与路易小体和路易神经突形成相关的神经元丢失）。在过去几十年中，富含黑质神经黑色素的投射细胞的严重受累受到了特别关注。这种病变干扰了纹状体的正常功能，可能是帕金森病中典型出现的许多运动功能障碍的原因。黑质以外的几个区域和核团同样严重受累，这一点常常被忽视。然而，除非考虑到这些黑质外区域的变化，否则无法完整描述帕金森病的病理学特征。将边缘系统和运动系统的示意图结合起来，有助于解释这种特征性的病变模式。这种方法揭示了杏仁核及相关结构在黑质外病理学中的关键作用。中央杏仁核、以非特异性方式投射到大脑皮层的核团以及调节内分泌和自主功能的核团都出现了严重病变。有人认为，黑质外病变会导致行为改变和自主神经功能障碍的发生。
