Sakai K, Kojima E, Suzuki M, Ugawa Y, Terao Y, Hanajima R, Kanazawa I
Department of Neurology, Graduate School of Medicine, University of Tokyo, Japan.
J Neurol Sci. 1998 Feb 18;155(1):115-9. doi: 10.1016/s0022-510x(97)00270-0.
We present a left-sided hemiplegic patient with a cerebrovascular lesion involving the medial part of the right frontal and parietal lobes and the corpus callosum, but sparing the hand area of right primary motor cortex (M1). Several studies using transcranial magnetic stimulation demonstrated functional integrity of the efferent pathways from the right M1, intact sensory afferents to M1, an impairment of transcallosal connection between the bilateral motor cortices, and reduced ipsilateral cortico-cortical inhibition within the right M1. Based on these results, we conclude that the paralysis of this patient was caused by disconnection of the intact M1 from any structures requisite for initiation of movements. The present patient also suggests the importance of various afferents to M1 in voluntary movement. We propose a term of 'primary motor cortex isolation' to designate the paralysis reported here.
我们报告了一名左侧偏瘫患者，其脑血管病变累及右侧额叶和顶叶的内侧部分以及胼胝体，但右侧初级运动皮层（M1）的手部区域未受影响。多项使用经颅磁刺激的研究表明，右侧M1传出通路功能完整，M1的感觉传入完整，双侧运动皮层之间的胼胝体连接受损，且右侧M1内同侧皮质-皮质抑制减弱。基于这些结果，我们得出结论，该患者的瘫痪是由于完整的M1与启动运动所需的任何结构断开连接所致。该患者还提示了各种传入M1的神经在自主运动中的重要性。我们提出“初级运动皮层孤立”这一术语来描述此处报告的瘫痪情况。
