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Vascular Lesions of the Thalamus-Incidence and Clinicopathologic Features M. Kameyama 1,2 1Yokufukai Geriatric Hospital, Third Clinic of Internal Medicine 2Faculty of Medicine, Univ. of Tokyo. pp.821-842
Published Date 1964/11/25
DOI https://doi.org/10.11477/mf.1431904138
  • Abstract
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The brains of 600 cases aged sixty and overwhich had undergone routine autopsy at the Yoku-fukai Geriatric Hospital were intensively studied.The exact site and size of thalamic lesions weredetermined on histologic preparations.

1. From the practical point of view, cerebralhemorrhage and infarction were subdivided, accord-ing to their size and clinical significance, into threegroups: large (fatal within one month after theonset), medium-sized (non-fatal with clinical mani-festations), and small (less than 0.5cm. in all dim-ensions, without clinical signs). Thalamic hemorr-hage was found in 38% of "large," in 43% of"medium-sized," and in 45% of "small" groups.Infarction involved the thalamus in 0% of "lar-ge," 14% of "mediumsized," and 31% of "small"groups. About 70% of medium-sized or small tha-lamic lesions were located in the lateral nuclei.Arterial or arteriolar fibrinoid changes, regardedas an important causative vascular pathology ofcerebral hemorrhage or small infarction in hyper-tensive subjects, were most frequently seen in theposterior half of the thalamus, i. e., within theterritories of the thalmogeniculate mail thalamoperfo-rate arteries.

2. An embryonic derivation of the posteriorcerebral artery from the internal carotid was obse-rved in 37% of all cases examined. Thalamiclesions were significantly lateralized to the side ofthis variation.

3. Referable symptons of thalamic massive he-morrhage at the initial phase of a stroke were asfollows: conjugate downward deviation of eyeballs,decerebrate rigidity, severe sensory disturbanceswith slight hemiparesis and deep coma without la-terality of motor signs.

4. Thalamic syndrome was rather infrequent inits complete form. Symptoms most characteristicand most commonly observed in lateral thalamiclesions were a combination of hemiparesis, sensorydisturbances including hyperpathia, dysesthesia, loss of deep sensation, or spontaneous pain, andataxia of the upper extremity of the involved side.Patterns of sensory symptoms were discussed froma view of local diagnosis.

5. Sites of lesions responsible for central painwere most frequently found in the suprathalamic,followed by the thalamic, pontine, and corticallevels. Mechanisms of central pain were brieflydiscussed.

6. Unilateral or bilateral involvement of thelitmus, including the medial nuclei as well as thecentrum medianum, was considered on clinical andanatomical grounds with case presentations, withthe conclusion that more emphasis should he laidon thalamic lesions in interpreting the organicbasis of neuropsychiatric phenomena of senilepatients.


Copyright © 1964, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1243 印刷版ISSN 0001-8724 医学書院

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