Hashimoto R, Kanho M, Fujimoto K, Tanaka Y
Department of Neurology, Jichi Medical School.
Rinsho Shinkeigaku. 1997 Apr;37(4):319-25.
We described a 48-year-old, right-handed woman who manifested left hand clumsiness after damage to the dorsal column of the high cervical cord due to probable multiple sclerosis. On February 29, 1996, she developed a weakness in the right limbs. Subsequently, she suffered numbness and clumsiness in the left limbs, even though muscle strength of the left limbs was preserved. Seventeen days later, she was referred to our hospital. A T2-weighted MRI after admission demonstrated high signal intensities in the left dorsal column and the right antero-lateral part of the cervical cord at the C1 to C3 vertebral level. Under the diagnosis of probable multiple sclerosis, steroid pulse therapy was applied twice and she gradually regained muscle strength in the right limbs and sensation in the left limbs. One month later, elemental sensations such as pain, touch, temperature, vibration, and position, as well as discriminative sensations such as localization sensation, two-point discrimination, barognosis, pinch-press discrimination, and graphesthesia in the left limbs returned to normal. However, her left hand remained clumsy, especially when she tried to manipulate objects. She also showed a great difficulty in sustaining a constant level of pinching force by the left thumb and index finger, and in localizing her right thumb placed in space with the left hand with her eyes closed. She stated herself that she could not sense at all how her left hand and fingers were moving. Somatosensory evoked potentials recorded from the right scalp showed that the NI was poorly organized and the patency of subsequent peaks was delayed. Transcranial magnetic stimulation revealed that the pyramidal tract from the right motor cortex to the left cervical cord was functionally intact. These observations lead us to conclude as follows: (1) the patient's left hand clumsiness is probably due to the disturbance of kinesthesia, which is crucial to activate temporo-spatial patterns of complex hand and finger movements as well as to maintain long sequences of simple motor execution without vision; and (2) kinesthesia is a specific sensation that is presumably conveyed by the dorsal columns and could be selectively affected by a cervical cord lesion.
我们描述了一名48岁的右利手女性，她因可能的多发性硬化导致高颈髓背柱受损后出现左手笨拙。1996年2月29日，她出现右肢无力。随后，她左肢出现麻木和笨拙，尽管左肢肌力正常。17天后，她被转诊至我院。入院后T2加权磁共振成像显示，在C1至C3椎体水平，左侧背柱和右侧颈髓前外侧部分有高信号强度。在可能的多发性硬化诊断下，给予两次类固醇脉冲治疗，她逐渐恢复了右肢肌力和左肢感觉。一个月后，左肢的疼痛、触觉、温度觉、振动觉和位置觉等基本感觉，以及定位觉、两点辨别觉、重量辨别觉、捏压辨别觉和图形觉等辨别性感觉恢复正常。然而，她的左手仍然笨拙，尤其是在试图操作物体时。她还表现出用左手拇指和食指持续保持恒定捏力以及闭眼时用左手定位置于空间中的右手拇指有很大困难。她自述完全感觉不到左手和手指的运动情况。从右侧头皮记录的体感诱发电位显示，N1波的波形紊乱，后续波峰的出现延迟。经颅磁刺激显示，从右运动皮层到左颈髓的锥体束功能完好。这些观察结果使我们得出以下结论：（1）患者左手笨拙可能是由于运动觉障碍，运动觉对于激活复杂手部和手指运动的时空模式以及在无视觉情况下维持简单运动执行的长序列至关重要；（2）运动觉是一种特定的感觉，大概由背柱传导，可能会被颈髓病变选择性地影响。
