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[Hemiparesis with lingual involvement. Hematoma of the genu of the internal capsule].

A 62 year-old hypertensive patient with a small left lenticulo-capsular hematoma presented with a right facio-brachial hemiparesis, dysarthria, and a right lingual paresis. The hematoma was limited to the genu and the anterior part of the posterior limb of the internal capsule. The occurrence of this incomplete pseudo-opercular syndrome in relation to a capsular lesion provides evidence for a cortico-hypoglossal projection with predominantly crossed fibers. The situation of the pyramidal tract in the internal capsule is considered.

Cerebral Hemorrhage↗

Hemichorea-hemiballism and anosognosia following a contralateral infarction of the caudate nucleus and anterior limb of the internal capsule.

The authors describe a patient who experienced the sudden occurrence of hemicorea-hemiballism on the left side of the body and the contemporary agnosia of it. An unenhanced CT-scan disclosed an ischemic lesion involving the head of the caudate nucleus and of the anterior limb of the internal capsule of the contralateral hemisphere. The authors discuss the possible pathophysiologic mechanisms explaining the rare association of these two symptoms and suggest that the involvement of the pyramidal tract in the internal capsule usually does not allow hyperkinesis to manifest itself.

Aged↗

Effect of electrical stimulation of the internal capsule on nociceptive neurons responding to orofacial stimuli in the medullary dorsal horn of the rat.

Internal capsule (IC) stimulation has been used clinically to alleviate central pain. However, the neuronal mechanisms underlying pain relief by IC stimulation are poorly understood. In order to elucidate the analgesic mechanism, the effect of IC conditioning stimulation on nociceptive neurons in the rat medullary dorsal horn was investigated in the present study. Rats were anaesthetized with N(2)O-O(2) (2:1) and 0.5% halothane and were immobilized with pancuronium bromide. Two kinds of nociceptive neurons, wide dynamic range (WDR) and nociceptive specific (NS) neurons, responding to noxious stimulations of the face and oral structures were recorded in the trigeminal caudal nucleus and the medial reticular subnuclei. A test stimulus with a single rectangular pulse (2ms in duration, 5-70V) was applied to the centre of the receptive field. Responses in 55.9% of the WDR neurons and in 60% of the NS neurons were inhibited by conditioning stimuli to the ipsilateral IC with trains of 33 pulses (100-300microA) at 330Hz. The percents of peak inhibitory effects on WDR neurons and NS neurons were 78.1+/-25.0% (n=19) and 89.0+/-13.6% (n=3), respectively. The inhibitory effect continued for conditioning-test intervals of up to 500ms. Effective sites for conditioning stimulation were concentrated in the lateral side of the IC. These findings suggest that modulation of nociceptive transmission by IC stimulation occurs at second-order neurons via a presynaptic phenomenon by corticofugal fibers in the IC.

Animals↗

The human thalamocortical sensory path in the internal capsule: evidence from a small capsular hemorrhage causing a pure sensory stroke.

A patient is presented who suffered a strokelike event during life that resulted in a hemisensory dificit for some modalities. On pathological examination of the brain, the lesion responsible for the deficit was found to be a small slit hemorrhage located in the posterior limb of the internal capsule adjacent to and minimally involving the thalamus. Clinicopathological correlation suggests that the sensory thalamocortical radiations must lie farther posterior in the posterior limb of the internal capsule than the corticospinal motor fibers, and that they probably lie adjacent to the thalamus. The case emphasizes that small slit hemorrhages deep in the brain, although rare, must be considered in the differential diagnosis of sudden hemisensory deficits.

Aged↗

Morphological asymmetry in anterior limb of human internal capsule revealed by confocal laser and polarized light microscopy.

The fiber structure in the anterior limb of the internal capsule was investigated in a region where stereotactic lesions (anterior capsulotomy) result in successful treatment of obsessive-compulsive disorder (OCD). Eight human hemispheres were sectioned in comparable planes parallel to the ACPC plane. Microscopic slices were labeled with DiI and analyzed with confocal laser and polarized light microscopy. Three distinct systems of fibers were detected. Single fibers run from the caudate nucleus to the lentiform nucleus. The anterior thalamic peduncle connects the mediodorsal and partially the anterior thalamic nucleus with the frontal lobe. The frontopontine tract system connects the frontal lobe with the pons. This fiber tract occupies 38% of the anterior limb and is arranged in small bands. Right-left comparison of morphometric parameters of these bundles demonstrated that more and smaller bundles were located on the left-hand side than on the right-hand side. Tendencies for this configuration were noticeable in all brains investigated, with statistical significance in one brain. These morphological differences correlate with functional differences, as it was possible to demonstrate right hemispheric dysfunctions in cases of OCD. The benefit of anterior capsulotomy in OCD is generally seen in the interruption of fronto-basal ganglia-thalamic loops by disconnecting the anterior thalamic peduncle. In addition, the frontopontine fiber tract is disconnected in this stereotactic procedure.

Aged↗

Sonography of the internal capsule and basal ganglia in infants. Part II. Localization of pathologic processes in the sagittal section through the caudothalamic groove.

Sagittal sonograms through the caudothalamic groove routinely display a gangliothalamic ovoid delimited by the lateral ventricle, the perimesencephalic cistern, and the radiations of the corpus callosum. The caudothalamic groove divides the superior surface of the ovoid into an anterior caudate arc and a posterior thalamic arc. The cerebral peduncle divides the inferior surface of the ovoid into an anterior ganglial arc, a middle peduncular arc, and a posterior thalamic arc. The genu of internal capsule constantly courses from the anterior end of the caudothalamic groove down to the peduncular arc and is easily identified. The gangliothalamic ovoid exhibits four obliquely oriented bands of increased and decreased echogenicity. The anteriormost hyperechoic band 1 corresponds to the head of the caudate nucleus. Hypoechoic band 2 corresponds to the globus pallidus, genu of the internal capsule, and cerebral peduncle. Hyperechoic band 3 corresponds to the ventral and lateral thalamic nuclei (exclusive of the pulvinar). Hypoechoic band 4 corresponds to the pulvinar. Lesions of the medial nucleus of the globus pallidus appear as hyperechoic foci that abut on the anterior surface of genu just above the peduncle and that have a narrow convex caudal margin. Lesions of the lateral nucleus of globus pallidus abut on the genu distant from the peduncle, spare the medial nucleus adjacent to the peduncle, and have a broad caudal border. Lesions of the head of caudate nucleus affect the anterior pole of the ovoid; those of the body affect the caudate arc superior to the caudothalamic groove. Thalamic lesions increase the echogenicity of bands 3 and 4.

Corpus Striatum↗

[Diaschisis in right putaminal hemorrhage: correlation with the degree of the extension to the internal capsule and the volume of hematoma].

Local cerebral lesions may cause depression of function in remote areas of the brain presumably by a transneural mechanism. This has been called "diaschisis". In the present study, regional brain blood flow in hypertensive right putaminal hemorrhage was studied in 33 patients (mean age, 55 year; 22 men, 11 women) to investigate the relationship between the degree in damage of the original lesions and "diaschisis". The hematoma was treated conservatively in 8 patients, aspirated stereotaxically in 9 patients, and evacuated through craniotomy in 16 patients. The regional blood flow in bilateral motor cortices and bilateral cerebellar hemispheres was measured by a single photon emission CT with N-isopropyl-p- [123 I] iodo-amphetamine intravenous injection, and was evaluated by the RI count on early image/the decay-corrected RI count on delayed image (E/D). The regional brain blood flow was measured for 29 to 35 days from the onset. There was a negative correlation between the degree of the extension to the internal capsule and the regional blood flow of the right motor cortex and the bilateral cerebellar hemispheres. There was also a negative correlation between the volume of the hematoma and the regional blood flow of the right motor cortex and the bilateral cerebellar hemispheres. The regional blood flow of the left motor cortex correlated with neither the degree of the extension to the internal capsule nor the volume of the hematoma. On the other hand, there was a positive correlation in the regional blood flow between the bilateral motor cortices.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Two-dimensional population map of cortical connections in the human internal capsule.

PURPOSE: To exploit diffusion imaging tractography to produce a two-dimensional (xy) probabilistic population map of the cortical connections within the human internal capsule (IC). MATERIALS AND METHODS: Diffusion tensor imaging (DTI) was carried out on 11 healthy volunteers. We parceled an axial section of the IC according to its connections to the prefrontal, premotor, primary motor, primary somatosensory, posterior parietal, and occipital cortices using our locally developed probabilistic algorithm. RESULTS: A consistent topographical organization was generated that was consistent with our anatomical knowledge of the IC. In addition, our study shows that in humans the anterior half of the IC is occupied by the prefrontal cortex. CONCLUSION: This map may be of clinical use for correlating neurological deficit with hemispheric lesions, particularly those that affect sensorimotor function.

Adult↗

Location of the corticospinal tract in the internal capsule at MR imaging.

PURPOSE: To examine whether hyperintense foci in the posterior internal capsule (IC) on T2-weighted magnetic resonance (MR) images represent fibers of the corticospinal tract (CST). MATERIALS AND METHODS: The authors reviewed MR images of 100 control subjects and 35 patients with amyotrophic lateral sclerosis (ALS) and brain specimens from seven control subjects and five ALS patients. RESULTS: In the posterior IC, the brain specimens from control subjects demonstrated a pale area with large axons and thick myelin sheaths. In five ALS patients, the brain specimens showed degeneration of the CST in the same region. MR images demonstrated abnormal hyperintensity that represented degeneration of the CST in five of 35 ALS patients. In the same region, hyperintense foci were found in the control subjects. CONCLUSION: Normal hyperintense foci in the IC represent the fibers of the CST. The presence of large fibers with thick myelin sheaths may play an important role in these signal intensity variations.

Aged↗

Age-related changes in the posterior limb of the internal capsule revealed by magnetic resonance imaging.

In this study, we examined the age-related differences in the corticospinal tract (CST) of the posterior limb (PL) of the internal capsule (IC) by analyzing 53 magnetic resonance (MR) images from 45 subjects. Regions in the posterior part of the PL of the IC were observed as hypointense areas in T1-weighted images of axial sections at 4 years of age. These regions became clear, spotty hyperintense areas in T2-weighted images of subjects older than 9 years. These regions persisted in all cases beyond 9 years of age, level on both T1- and T2-weighted images. The region is consistent with the CST from MR images of coronal and sagittal sections in our study. These results suggest that differences among the region may occur, such as an increase in fiber size and an increase in the thickness of the myelin sheaths, depending on age after the completion of general myelination in the CST.

Adolescent↗

[Left motor extinction due to an ischemic lesion of the anterior limb of the internal capsule (author's transl)].

An ischemic lesion limited to the anterior limb of the internal capsule provoked a left motor neglect in a 64-year-old man. There was reduction in spontaneous mobility of the left side of the body, reversible during verbal incitations and accompanied by motor extinction. There were no perceptive disorders, or visual, somatesthetic, or auditive neglect. The importance of the motor extinction phenomenon (described by Valenstein and Heilman in a case with a lesion of similar site) is emphasized: it demonstrates the role in motor neglect of a disequilibrium in intentional activation of the hemispheres. Pathological and clinical correlations are discussed in relation to cases reported in the literature and the results of animal studies. It is suggested that motor neglect may result from interruption of connections between the median thalamic nuclei, the striatum, and the frontal cortex. Relationships between motor neglect and perceptive (attentional) neglect syndromes are discussed.

Brain Ischemia↗

Persistent mutism and dysphagia of acute onset due to bilateral internal capsule infarction.

Acute mutism with paralysis of the bulbar and facial muscles following discrete bilateral internal capsular infarction is a rare stroke syndrome. We describe a 62 year-old male who suddenly became unable to speak or swallow. The paucity of facial expression and inability to voluntarily move the facial, lingual and pharyngeal muscles were persistent and contrasted with a relatively mild limb paresis which recovered. High resolution CT scan revealed infarcts in the posterior limbs of both internal capsules. It is important to recognise this stroke syndrome because of the permanence of dysarthria and dysphagia associated with it.

Bulbar Palsy, Progressive↗

Antero-posterior localization of the pyramidal tract in the internal capsule in a living patient.

A lacunar infarction occurred in the posterior limb of the internal capsule in a 33-years-old Colombian woman, showed an antero-posterior (A-P) course of the corticospinal pathway. Anatomical and histological studies had suggested this course, but to the author's knowledge, this could be the first reported case of a living patient with such features, confirming those previous reports about them.

Adult↗

[Cerebral edema extending to the posterior limb of the internal capsule on MR imaging].

The features of edema extending to the posterior limb of the internal capsule (PLIC) were investigated in a review of MR imaging (MRI), with the following results. Edema was seen along the lateral and medial margins of the PLIC, although the PLIC itself was resistant to edema. The edema along the lateral and medial margins tended to extend into the lentiform nucleus and thalamus, respectively, and was considered to be edema of the extrapyramidal and thalamocortical tracts. When edema was abundant, the PLIC was traversed by many edematous tracts which seemed to connect the lentiform nucleus with the thalamus. The PLIC looked like a comb, and this finding was a good anatomical landmark on MR T 2-weighted images. We have used the term "comb appearance" to describe this finding.

Brain↗

Oral administration of metal chelator ameliorates motor dysfunction after a small hemorrhage near the internal capsule in rat.

Cerebral hemorrhage leads to local production of free iron, radicals, cytokines, etc. To investigate whether a decrease of iron-mediated radical production influences functional recovery after intracerebral hemorrhage (ICH), a modified ICH rat model with a small hemorrhage near the internal capsule (IC) accompanied with relatively severe motor dysfunction was first developed. Then clioquinol (CQ), an iron chelator that reduces hydroxyl radical production, was orally administrated. Injection of different doses of Type IV collagenase (1.4 mul 1-200 U/ml) into the left striatum near the IC in Wistar rats showed that injection of 7.5 U/ml collagenase resulted in a small hemorrhoidal lesion near the IC with relatively severe motor dysfunction (IC model). Retrograde labeling of neurons in the sensory-motor cortex and axons in the corticospinal tract using Fluoro-gold (FG) injection into the spinal cord (C3-C4) showed that few labeled neurons in the sensory-motor cortex were detected in the IC model, FG-labeled axons disappeared, and FG-including ED-1-positive cells appeared within 24 hr in the IC. Assessments of behavior and histologic analysis after oral administration of CQ in the IC model indicated that oral administration of CQ prevented a decrease of FG-labeled neurons, and resulted in better motor-function recovery. CQ inhibited hydrogen peroxide-induced cell toxicity in oligodendrocytes in vitro, but not in neurons. Our data suggests that CQ ameliorated motor dysfunction after a small hemorrhage near the IC by a mechanism that is related to reduction of chain-reactive hydroxyl radical production in oligodendrocytes.

Administration, Oral↗

Expression of MAP1a and MAP1b in the ganglionic eminence and the internal capsule of the human fetal brain.

The expression of microtubule-associated proteins 1a and 1b (MAP1a and 1b) were investigated in two transient structures, the ganglionic eminence (GE) being a prominent part of the telencephalic proliferative zone and the perireticular nucleus (PR) within the internal capsule (IC). Anti-MAP1a immunolabels PR neurons from 18 weeks of gestation (wg) onwards, whereas anti-MAP1b immunolabels long IC fibers between 18 and 22 wg. MAP1b is further present in thalamic fibers that seem to terminate at the medial margin of the GE, in a moderate number of cells of the GE and its medial extension, the gangliothalamic body (GTB). From 26 to 33 wg MAP1b is expressed in short fiber bundles of the IC, a few MAP1b-positive cells are seen in the GE. MAP1a has so far been described to appear in differentiated neurons and to be related to late developmental events. However, the transient PR being involved in axonal guidance as an intermediate target shows a precocious MAP1a-expression. The MAP1b-finding that thalamocortical fibers accumulate at the GE-margin indicates that this region represents an intermediate target for these fibers. The short MAP1b fiber bundles found in the IC are in accordance with cell culture experiments showing that MAP1b is concentrated in distal parts of outgrowing axons.

Cell Differentiation↗

Reversible reduction of apparent diffusion coefficient values in bilateral internal capsules in transient hypoglycemia-induced hemiparesis.

A woman aged 68 years who experienced recurrent right hemiparesis caused by hypoglycemia was admitted to our hospital. When she was experiencing a low level of glucose, diffusion-weighted MR imaging showed the presence of hyperintensity lesions in the bilateral internal capsule. Diffusion-weighted MR imaging has been infrequently performed in patients with hypoglycemia. We report the reversible hyperintensity lesions on diffusion-weighted MR imaging in a hypoglycemic period in a patient with reversible hemiparesis. A reduction of apparent diffusion coefficient in a hypoglycemic period was clearly shown.

Aged↗

[The value of the internal capsule signs in the stimulation of the subthalamic nucleus in Parkinson's disease].

INTRODUCTION: The effectiveness of stimulating the subthalamic nucleus (DBS-STN) in advanced Parkinson's disease (PD) largely depends on the correct placement of the electrodes. Since the sensory-motor region of the STN lies beside the internal capsule (IC), we believe that the motor effectiveness of DBS-STN could be related to the stimulation threshold in which IC signs appear (IC threshold). PATIENTS AND METHODS: An examination of 17 consecutive patients with advanced PD who had been submitted to bilateral DBS-STN (one case was unilateral) was carried out to determine the motor improvement on each side of the body (n = 33) and the energy consumption one year after surgery according to the IC threshold obtained during the programming. RESULTS: A 45% improvement was observed in the UPDRS III in off and there was a 24% reduction in the equivalent dose of levodopa with bilateral DBS-STN. When the electrodes were considered, there was a statistically significant improvement that depended on the IC threshold. Energy consumption differed significantly between electrodes with an IC threshold of 3-7 V (1.5 +/- 1.2 microW) and those with an IC threshold > 7 V (8.3 +/- 9.4 microW). CONCLUSIONS: During the stimulation phase and following the correct location of the STN, which was achieved by neurophysiological recording, the IC threshold has prognostic implications in medium-long term motor effectiveness and in the consumption of the battery in the generator.

Aged↗