Urban P P, Hopf H C, Zorowka P G, Fleischer S, Andreas J
Department of Neurology, University of Mainz, Germany.
Neurology. 1996 Nov;47(5):1135-41. doi: 10.1212/wnl.47.5.1135.
We investigated the supranuclear tracts involved in speech production in 8 patients with dysarthria associated with a single lacunar stroke. Magnetic resonance imaging revealed the lesion site in 7 out of 8 patients. We tested corticobulbar tract function using transcranial magnetic stimulation and demonstrated impairment of the corticolingual projections in all the patients and in 5 patients impairment of the corticofacial projections. Sensory function in the oral cavity was impaired in 1 out of 8 patients. 99mTc hexamethyl-propylene amine oxime-single-photon emission computerized tomography (HMPAO-SPECT) imaging, performed in 5 patients, showed cerebellar diaschisis in 1, suggesting additional cerebropontocerebellar tract impairment. Dysarthria observed in the 2 patients with impaired sensation in the oral cavity or with cerebellar diaschisis did not differ from the dysarthria found in the other patients. We conclude that interruption of the corticolingual pathways to the tongue is crucial in the pathogenesis of dysarthria following extracerebellar lacunar stroke.
我们对8例与单发腔隙性卒中相关的构音障碍患者参与言语产生的核上传导束进行了研究。磁共振成像显示8例患者中有7例的病变部位。我们使用经颅磁刺激测试皮质延髓束功能，结果表明所有患者的皮质 - 舌投射均受损，5例患者的皮质 - 面投射受损。8例患者中有1例口腔感觉功能受损。对5例患者进行了99mTc六甲基丙烯胺肟 - 单光子发射计算机断层扫描（HMPAO - SPECT）成像，其中1例显示小脑失联络，提示存在额外的脑桥小脑束损伤。在口腔感觉受损或有小脑失联络的2例患者中观察到的构音障碍与其他患者的构音障碍并无差异。我们得出结论，小脑外腔隙性卒中后构音障碍发病机制中，通向舌部的皮质 - 舌通路中断至关重要。
