Kuriyama N, Yamamoto Y, Akiguchi I, Oiwa K, Nakajima K
Department of Neurology, Kyoto Second Red Cross Hospital.
Rinsho Shinkeigaku. 1997 Nov;37(11):1014-20.
We reported a 67-year-old woman with bilateral caudate head infarcts. She developed sudden mutism followed by abulia. She was admitted to our hospital 2 months after ictus for further examination. She showed prominent abulia and was inactive, slow and apathetic. Spontaneous activity and speech, immediate response to queries, spontaneous word recall and attention and persistence to complex programs were disturbed. Apparent motor disturbance, gait disturbance, motor aphasia, apraxia and remote memory disturbance were not identified. She seemed to be depressed but not sad. Brain CT and MRI revealed bilateral caudate head hemorrhagic infarcts including bilateral anterior internal capsules, in which the left lesion was more extensive than right one and involved the part of the left putamen. These infarct locations were thought to be supplied by the area around the medial striate artery including Heubner's arteries and the A1 perforator. Digital subtraction angiography showed asymptomatic right internal carotid artery occlusion. She bad had hypertension, diabetes mellitus and atrial fibrillation and also had a left atrium with a large diameter. The infarcts were thought to be caused by cardioembolic occlusion to the distal portion of the left internal carotid artery. Although some variations of vasculature at the anterior communicating artery might contribute to bilateral medial striate artery infarcts, we could not demonstrate such abnormalities by angiography. Bilateral caudate head infarcts involving the anterior internal capsule may cause prominent abulia. The patient did not improve by drug and rehabilitation therapy and died suddenly a year after discharge.
我们报告了一名67岁患有双侧尾状核头部梗死的女性。她突发缄默症，随后出现意志缺失。发病2个月后她被收入我院做进一步检查。她表现出明显的意志缺失，不活动、动作迟缓且冷漠。自发活动和言语、对询问的即时反应、自发单词回忆以及对复杂程序的注意力和坚持力均受到干扰。未发现明显的运动障碍、步态障碍、运动性失语、失用症和远期记忆障碍。她似乎情绪低落但并不悲伤。脑部CT和MRI显示双侧尾状核头部出血性梗死，包括双侧前内侧囊，其中左侧病变比右侧更广泛，累及左侧壳核部分。这些梗死部位被认为由包括Heubner动脉和A1穿支在内的内侧纹状动脉周围区域供血。数字减影血管造影显示右侧颈内动脉无症状性闭塞。她患有高血压、糖尿病和心房颤动，且左心房直径较大。梗死被认为是由左颈内动脉远端的心源性栓塞性闭塞所致。尽管前交通动脉处的血管存在一些变异可能导致双侧内侧纹状动脉梗死，但我们通过血管造影未发现此类异常。累及前内侧囊的双侧尾状核头部梗死可能导致明显的意志缺失。该患者经药物和康复治疗后未改善，出院一年后突然死亡。
