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Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 2000 Oct;69(4):494–498. doi: 10.1136/jnnp.69.4.494

Unilateral lesions of the globus pallidus: report of four patients presenting with focal or segmental dystonia

A Munchau 1, D Mathen 1, T Cox 1, N Quinn 1, C Marsden 1, K Bhatia 1
PMCID: PMC1737132  PMID: 10990510

Abstract

OBJECTIVES—To interpret clinical features after unilateral lesions of the globus pallidus on the basis of physiology of the basal ganglia.
METHODS—Four patients with unilateral lesions in the globus pallidus (GP) were clinically examined and the literature on patients with pallidal lesions was reviewed.
RESULTS—Three patients presented with contralateral dystonia largely confined to one arm in one case and one leg in two cases. One patient had predominant contralateral hemiparkinsonism manifested mainly as micrographia and mild dystonia in one arm. The cause of the lesions was unknown in two patients. In the other two symptoms had developed after head trauma and after anoxia. All lesions involved the internal segment of the GP. Two patients, including the patient with hemiparkinsonism, had additional involvement of the external segment of the GP. In the literature reports on 26 patients with bilateral lesions restricted to the GP only two with unilateral lesions were found. The patients with bilateral pallidal lesions manifested with dystonia, parkinsonism, or abulia. One of the patients with unilateral GP lesions had contralateral hemidystonia, the other contralateral arm tremor.
CONCLUSION—These cases emphasise the importance of the GP, particularly its internal segment, in the pathophysiology of dystonia.



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Selected References

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  1. Ali-Cherif A., Royere M. L., Gosset A., Poncet M., Salamon G., Khalil R. Troubles du comportement et de l'activité mentale après intoxication oxycarbonée. Lésions pallidales bilatérales. Rev Neurol (Paris) 1984;140(6-7):401–405. [PubMed] [Google Scholar]
  2. Bhatia K. P., Marsden C. D. The behavioural and motor consequences of focal lesions of the basal ganglia in man. Brain. 1994 Aug;117(Pt 4):859–876. doi: 10.1093/brain/117.4.859. [DOI] [PubMed] [Google Scholar]
  3. Bucher S. F., Seelos K. C., Dodel R. C., Paulus W., Reiser M., Oertel W. H. Pallidal lesions. Structural and functional magnetic resonance imaging. Arch Neurol. 1996 Jul;53(7):682–686. doi: 10.1001/archneur.1996.00550070124020. [DOI] [PubMed] [Google Scholar]
  4. Burke R. E., Fahn S., Gold A. P. Delayed-onset dystonia in patients with "static" encephalopathy. J Neurol Neurosurg Psychiatry. 1980 Sep;43(9):789–797. doi: 10.1136/jnnp.43.9.789. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Crossman A. R., Brotchie J. M. Pathophysiology of dystonia. Adv Neurol. 1998;78:19–25. [PubMed] [Google Scholar]
  6. DeLong M. R., Crutcher M. D., Georgopoulos A. P. Primate globus pallidus and subthalamic nucleus: functional organization. J Neurophysiol. 1985 Feb;53(2):530–543. doi: 10.1152/jn.1985.53.2.530. [DOI] [PubMed] [Google Scholar]
  7. Dooling E. C., Adams R. D. The pathological anatomy of posthemiplegic athetosis. Brain. 1975 Mar;98(1):29–48. doi: 10.1093/brain/98.1.29. [DOI] [PubMed] [Google Scholar]
  8. Eidelberg D. Abnormal brain networks in DYT1 dystonia. Adv Neurol. 1998;78:127–133. [PubMed] [Google Scholar]
  9. Gruber Gikovate C., Zirretta J. C., Ferreira Bezerra J. M., Canedo de Magalhães G., Barkovich A. J. Transient globus pallidus T1 shortening associated with polycythaemia and dystonia. Neuroradiology. 1999 Apr;41(4):288–291. doi: 10.1007/s002340050750. [DOI] [PubMed] [Google Scholar]
  10. Hamada I., DeLong M. R. Excitotoxic acid lesions of the primate subthalamic nucleus result in reduced pallidal neuronal activity during active holding. J Neurophysiol. 1992 Nov;68(5):1859–1866. doi: 10.1152/jn.1992.68.5.1859. [DOI] [PubMed] [Google Scholar]
  11. Hawker K., Lang A. E. Hypoxic-ischemic damage of the basal ganglia. Case reports and a review of the literature. Mov Disord. 1990;5(3):219–224. doi: 10.1002/mds.870050306. [DOI] [PubMed] [Google Scholar]
  12. Iacono R. P., Kuniyoshi S. M., Lonser R. R., Maeda G., Inae A. M., Ashwal S. Simultaneous bilateral pallidoansotomy for idiopathic dystonia musculorum deformans. Pediatr Neurol. 1996 Feb;14(2):145–148. doi: 10.1016/0887-8994(96)00003-3. [DOI] [PubMed] [Google Scholar]
  13. Klawans H. L., Stein R. W., Tanner C. M., Goetz C. G. A pure parkinsonian syndrome following acute carbon monoxide intoxication. Arch Neurol. 1982 May;39(5):302–304. doi: 10.1001/archneur.1982.00510170044012. [DOI] [PubMed] [Google Scholar]
  14. Krystkowiak P., Martinat P., Defebvre L., Pruvo J. P., Leys D., Destée A. Dystonia after striatopallidal and thalamic stroke: clinicoradiological correlations and pathophysiological mechanisms. J Neurol Neurosurg Psychiatry. 1998 Nov;65(5):703–708. doi: 10.1136/jnnp.65.5.703. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Laplane D., Levasseur M., Pillon B., Dubois B., Baulac M., Mazoyer B., Tran Dinh S., Sette G., Danze F., Baron J. C. Obsessive-compulsive and other behavioural changes with bilateral basal ganglia lesions. A neuropsychological, magnetic resonance imaging and positron tomography study. Brain. 1989 Jun;112(Pt 3):699–725. doi: 10.1093/brain/112.3.699. [DOI] [PubMed] [Google Scholar]
  16. Lehéricy S., Vidailhet M., Dormont D., Piérot L., Chiras J., Mazetti P., Marsault C., Agid Y. Striatopallidal and thalamic dystonia. A magnetic resonance imaging anatomoclinical study. Arch Neurol. 1996 Mar;53(3):241–250. doi: 10.1001/archneur.1996.00550030051022. [DOI] [PubMed] [Google Scholar]
  17. Lenz F. A., Suarez J. I., Metman L. V., Reich S. G., Karp B. I., Hallett M., Rowland L. H., Dougherty P. M. Pallidal activity during dystonia: somatosensory reorganisation and changes with severity. J Neurol Neurosurg Psychiatry. 1998 Nov;65(5):767–770. doi: 10.1136/jnnp.65.5.767. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Lin J. J., Lin G. Y., Shih C., Lin S. Z., Chang D. C., Lee C. C. Benefit of bilateral pallidotomy in the treatment of generalized dystonia. Case report. J Neurosurg. 1999 May;90(5):974–976. doi: 10.3171/jns.1999.90.5.0974. [DOI] [PubMed] [Google Scholar]
  19. Lozano A. M., Kumar R., Gross R. E., Giladi N., Hutchison W. D., Dostrovsky J. O., Lang A. E. Globus pallidus internus pallidotomy for generalized dystonia. Mov Disord. 1997 Nov;12(6):865–870. doi: 10.1002/mds.870120606. [DOI] [PubMed] [Google Scholar]
  20. Maki Y., Akimoto H., Enomoto T. Injuries of basal ganglia following head trauma in children. Childs Brain. 1980;7(3):113–123. doi: 10.1159/000119936. [DOI] [PubMed] [Google Scholar]
  21. Marsden C. D., Obeso J. A., Zarranz J. J., Lang A. E. The anatomical basis of symptomatic hemidystonia. Brain. 1985 Jun;108(Pt 2):463–483. doi: 10.1093/brain/108.2.463. [DOI] [PubMed] [Google Scholar]
  22. Miwa H., Hatori K., Kondo T., Imai H., Mizuno Y. Thalamic tremor: case reports and implications of the tremor-generating mechanism. Neurology. 1996 Jan;46(1):75–79. doi: 10.1212/wnl.46.1.75. [DOI] [PubMed] [Google Scholar]
  23. Ondo W. G., Desaloms J. M., Jankovic J., Grossman R. G. Pallidotomy for generalized dystonia. Mov Disord. 1998 Jul;13(4):693–698. doi: 10.1002/mds.870130415. [DOI] [PubMed] [Google Scholar]
  24. Pettigrew L. C., Jankovic J. Hemidystonia: a report of 22 patients and a review of the literature. J Neurol Neurosurg Psychiatry. 1985 Jul;48(7):650–657. doi: 10.1136/jnnp.48.7.650. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Piccirilli M., Mazzi P., Luccioli R., Sciarma T. Selective bilateral lesion of the globus pallidus: ten-year follow-up of memory impairment and frontal symptomatology. Ital J Neurol Sci. 1995 Dec;16(9):635–640. doi: 10.1007/BF02230914. [DOI] [PubMed] [Google Scholar]
  26. Vitek J. L., Chockkan V., Zhang J. Y., Kaneoke Y., Evatt M., DeLong M. R., Triche S., Mewes K., Hashimoto T., Bakay R. A. Neuronal activity in the basal ganglia in patients with generalized dystonia and hemiballismus. Ann Neurol. 1999 Jul;46(1):22–35. doi: 10.1002/1531-8249(199907)46:1<22::aid-ana6>3.0.co;2-z. [DOI] [PubMed] [Google Scholar]
  27. Vitek J. L., Zhang J., Evatt M., Mewes K., DeLong M. R., Hashimoto T., Triche S., Bakay R. A. GPi pallidotomy for dystonia: clinical outcome and neuronal activity. Adv Neurol. 1998;78:211–219. [PubMed] [Google Scholar]

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