Tohgi H, Takahashi S, Takahashi H, Tamura K, Yonezawa H
Department of Neurology, Iwate Medical University, Japan.
Eur Neurol. 1996;36(6):338-42. doi: 10.1159/000117290.
The aim of this study was to investigate whether the side and location of single small infarcts (< or = 3 cm) in the corona radiata (28 patients) and pontine base (36 patients) influence the incidence of contralateral upper or lower limb paresis and dysarthria. While the severity of contralateral limb paresis was not significantly different between right and left corona radiata lesions, infarcts presenting with contralateral limb paresis and/or dysarthria presented significantly more often in the left than in the right hemisphere, and left infarcts were significantly smaller than right infarcts. Lesions related to dysarthria and upper and lower limb paresis were arranged anterior-posteriorly in the paraventricular corona radiata region. Pontine base infarcts presenting with dysarthria also presented significantly more often in the left than in the right pons. Dysarthria showed a significant correlation with lesions presenting in the dorsomedial portion of the pontine base, upper limb paresis with those in the dorsomedial and dorsolateral portions, and lower limb paresis with lesions in the ventromedial portion. These results suggest greater influence of the left descending motor fibers on contralateral limb movement and articulation than of the right and face-arm-leg somatotopy of motor fibers in the paraventricular corona radiata region (anteroposterior) and in the pontine base (dorsoventral).
本研究的目的是调查放射冠（28例患者）和脑桥基底部（36例患者）单个小梗死灶（≤3 cm）的部位和位置是否会影响对侧上肢或下肢轻瘫及构音障碍的发生率。虽然放射冠左右两侧病变所致对侧肢体轻瘫的严重程度无显著差异，但导致对侧肢体轻瘫和/或构音障碍的梗死灶在左侧半球的出现频率显著高于右侧，且左侧梗死灶明显小于右侧梗死灶。与构音障碍及上肢和下肢轻瘫相关的病变在脑室旁放射冠区域呈前后排列。脑桥基底部梗死所致构音障碍在左侧脑桥的出现频率也显著高于右侧。构音障碍与脑桥基底部背内侧部的病变显著相关，上肢轻瘫与背内侧部和背外侧部的病变相关，下肢轻瘫与腹内侧部的病变相关。这些结果表明，左侧下行运动纤维对对侧肢体运动和发音的影响大于右侧，且在脑室旁放射冠区域（前后方向）和脑桥基底部（背腹方向）存在面-臂-腿运动纤维的躯体定位关系。
