% 0期刊文章% Richard玉石David J林% %一个朱莉DiCarlo %悉尼麦基尔南% B塞缪尔·斯奈德%汉娜雅各布斯%金伯利S话务量%一个皮尔斯博因河凯利Rishe % %杰夫•戈德史密斯%杰西卡Ranford % Seth p . Finklestein %一个李h . Schwamm %业务利R %史蒂文·c·克莱默% T区分不同的近端和远端神经系统急性中风后上肢运动控制% D R 10.1212 / WNL 2023%。0000000000207417 % J首页神经病学% P 10.1212 / WNL。0000000000207417 X %的背景和目标:经典和奇异的模式远比上肢近端电动机赤字急性中风后不占不同的结构和功能组织的近端和远端电动机控制电路健康的中枢神经系统。我们假设单独的近端和远端上肢急性中风后临床症状可能是杰出的,模式的神经解剖学的损伤导致这两个症状会反映出他们不同的组织完整的中枢神经系统。运动损伤的方法:近端和远端组件(上肢Fugl-Meyer分数)和力量(肩膀绑架手指扩展分数)在连续评估招募病人急性中风的7天之内。偏相关分析用于评估近端和远端运动成绩之间的关系。功能测试结果包括盒子和街区,Barthel指数和改良Rankin规模检查与近端和远端运动模式的赤字。分布lesion-symptom映射是用于识别损伤相关的近端和远端上肢运动赤字。结果:共有141个连续的患者(49%的女性)评估4.0±1.6(平均数±标准差)天后中风发病。单独的近端和远端上肢运动组件区分急性中风后(p = 0.002)。近端远端损伤(即多模式。,相对保存远端电动机控制)并不罕见,观察到23%的急性中风科目。相对保存患者远端运动控制,甚至在控制了总赤字的程度,最好的结果在第一周和90天中风后(框和块测试,ρ= 0.51,p < 0.001; Barthel Index, ρ = 0.41, p < 0.001; modified Rankin Scale, ρ = 0.38, p < 0.001). Deficits in proximal motor control were associated with widespread injury to subcortical white and gray matter, while deficits in distal motor control were associated with injury restricted to the posterior aspect of the precentral gyrus, consistent with the organization of proximal versus distal neural circuits in the healthy CNS.Conclusions: These results highlight that proximal and distal upper extremity motor systems can be selectively injured by acute stroke, with dissociable deficits and functional consequences. Our findings emphasize how disruption of distinct motor systems can contribute to separable components of post-stroke upper extremity hemiparesis. %U //www.ez-admanager.com/content/neurology/early/2023/06/02/WNL.0000000000207417.full.pdf