脳血管障害-研究と診療の進歩(1) : 脳卒中症候学における最近の話題

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  • ノウケッカン ショウガイ ケンキュウ ト シンリョウ ノ シンポ 1 ノウソッチュウ ショウコウガク ニ オケル サイキン ノ ワダイ
  • Cerebrovascular Disease : Recent Progress in Research and Clinical Practice (1) : Current Topics in Symptoms of Stroke

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Stroke symptomatology has developed dramatically with the advancement of cranial CT and MRI. The current topics of stroke symptomatology are introduced. First, the Oxfordshire Community Stroke Project (OCSP) classification allocates stroke patients into 4 groups based solely on symptoms. The tool is easy to apply and has a good interobserver reliability. It is able to predict prognosis and corresponds well with the lesion found on CT. Second, the Japan Stroke Scale (JSS) is a newly developed stroke scale in Japan. It quantitatively measures the severity of stroke patients. Each clinical factor on the severity scale has a relative weight. Pure monoparesis caused by small cortical or brainstem lesions are frequently reported symptoms. In particular, monoparesis of the hand following a localized infarction in the so-called "precentral knob" in the precentral gyrus are well recognized. Functional reorganization after a stroke is also recently recognized. For example, hyperkinetic motor behavior contralateral to hemiplegia after a severe hemispheric stroke is typical. It represents a clinical expression of early plastic changes of brain maps and circuits, which is an active process induced by a disinhibition to establish new compensatory pathways after an acute lesion. Pathological laughter is also another symptom after a stroke. Two dependent symptoms, voluntary facial paresis and emotional facial paresis, are commonly found. The former depends on the system in the premotor/frontal opercular areas through the pyramidal tract to the ventral brainstem, while the latter depends on the amygdala, thalamic and subthalamic areas and the dorsal or tegmental brainstem. Central facial paresis caused by medullary infarction is another recognized symptom. In some patients, the corticofacial fibers loop down into the ventral part of the upper medulla, cross the midline and ascend in the dorsolateral medullary region ipsilateral to the facial nucleus.

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