Skip to main content
PMC home page
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1998 Nov;65(5):703–708. doi: 10.1136/jnnp.65.5.703

Dystonia after striatopallidal and thalamic stroke: clinicoradiological correlations and pathophysiological mechanisms

P Krystkowiak 1, P Martinat 1, L Defebvre 1, J Pruvo 1, D Leys 1, A Destee 1
PMCID: PMC2170340  PMID: 9810942

Abstract

OBJECTIVE—To establish the pathophysiological mechanisms of striatopallidal and thalamic dystonia.
METHODS—Five patients from among 26 who presented (between March 1987 and July 1996) with focal dystonia, segmental dystonia, or hemidystonia caused by a single localised vascular lesion, were selected. Patients with lesions with indefinite boundaries, and diffuse, or multiple, or large brain lesions were excluded. Three dimensional T1 weighted MRI (1.5 tesla) was performed to determine the topography of the lesions. The atlas of Hassler allowed the stereotactic localisation of the lesions to be specified exactly.
RESULTS—Three patients had dystonic spasms associated with striatopallidal lesions and one with a thalamic and striatopallidal lesion. One other patient presented with a myoclonic dystonia related to a thalamic lesion. The striatopallidal lesions were located in the sensorimotor area with a somatotopical distribution. The pure thalamic lesion involved the centromedian nucleus, the sensory nuclei, and the pulvinar whereas the thalamic and striatopallidal lesion was located in the pallidonigral thalamic territory, which receives pallidonigral inputs.
CONCLUSION—The striatopallidal dystonia might be the consequence of the interruption of the cortico-striato-pallido-thalamo-cortical loop induced by lesions located within the sensorimotor part of the striatopallidal complex. By contrast, it is suggested that thalamic dystonia might be caused by lesions located in the centromedian or the ventral intermediate nuclei, outside the pallidonigral territory, but leading also to a dysfunction of the cort ico -striat o - pallido - thalamo - cort ica l loop.



Full Text

The Full Text of this article is available as a PDF (138.0 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alexander G. E., DeLong M. R., Strick P. L. Parallel organization of functionally segregated circuits linking basal ganglia and cortex. Annu Rev Neurosci. 1986;9:357–381. doi: 10.1146/annurev.ne.09.030186.002041. [DOI] [PubMed] [Google Scholar]
  2. Berkovic S. F., Bladin P. F. Rubral tremor: clinical features and treatment of three cases. Clin Exp Neurol. 1984;20:119–128. [PubMed] [Google Scholar]
  3. 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]
  4. Blepharospasm associated with palatal myoclonus and communicating hydrocephalus. Neurology. 1984 Nov;34(11):1522–1524. [PubMed] [Google Scholar]
  5. 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]
  6. Burton K., Farrell K., Li D., Calne D. B. Lesions of the putamen and dystonia: CT and magnetic resonance imaging. Neurology. 1984 Jul;34(7):962–965. doi: 10.1212/wnl.34.7.962. [DOI] [PubMed] [Google Scholar]
  7. CARPENTER M. B. A study of the red nucleus in the rhesus monkey; anatomic degenerations and physiologic effects resulting from localized lesions of the red nucleus. J Comp Neurol. 1956 Sep;105(2):195–249. doi: 10.1002/cne.901050204. [DOI] [PubMed] [Google Scholar]
  8. CARREA R. M., METTLER F. A. The anatomy of the primate brachium conjunctivum and associated structures. J Comp Neurol. 1954 Dec;101(3):565–689. doi: 10.1002/cne.901010303. [DOI] [PubMed] [Google Scholar]
  9. Ceballos-Baumann A. O., Passingham R. E., Marsden C. D., Brooks D. J. Motor reorganization in acquired hemidystonia. Ann Neurol. 1995 Jun;37(6):746–757. doi: 10.1002/ana.410370608. [DOI] [PubMed] [Google Scholar]
  10. Dann R., Hoford J., Kovacic S., Reivich M., Bajcsy R. Evaluation of elastic matching system for anatomic (CT, MR) and functional (PET) cerebral images. J Comput Assist Tomogr. 1989 Jul-Aug;13(4):603–611. doi: 10.1097/00004728-198907000-00009. [DOI] [PubMed] [Google Scholar]
  11. Day T. J., Lefroy R. B., Mastaglia F. L. Meige's syndrome and palatal myoclonus associated with brain stem stroke. A common mechanism? J Neurol Neurosurg Psychiatry. 1986 Nov;49(11):1324–1325. doi: 10.1136/jnnp.49.11.1324. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Destée A., Muller J. P., Vermersch P., Pruvo J. P., Warot P. Hémiballisme. Hémichorée. Infarctus striatal. Rev Neurol (Paris) 1990;146(2):150–152. [PubMed] [Google Scholar]
  13. Dewey R. B., Jr, Jankovic J. Hemiballism-hemichorea. Clinical and pharmacologic findings in 21 patients. Arch Neurol. 1989 Aug;46(8):862–867. doi: 10.1001/archneur.1989.00520440044020. [DOI] [PubMed] [Google Scholar]
  14. 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]
  15. Dormont D., Zerah M., Cornu P., Parker F., Aubert B., Sigal R., Francke J. P., Zouaoui A., Marsault C. A technique of measuring the precision of an MR-guided stereotaxic installation using anatomic specimens. AJNR Am J Neuroradiol. 1994 Feb;15(2):365–371. [PMC free article] [PubMed] [Google Scholar]
  16. FOLTZ E. L., KNOPP L. M., WARD A. A., Jr Experimental spasmodic torticollis. J Neurosurg. 1959 Jan;16(1):55–67. doi: 10.3171/jns.1959.16.1.0055. [DOI] [PubMed] [Google Scholar]
  17. Fahn S. Concept and classification of dystonia. Adv Neurol. 1988;50:1–8. [PubMed] [Google Scholar]
  18. GARCIN R. Syndrome cérébello-thalamique par lésion localisée du thalamus; avec une digression sur le signe de la main creuse et son intérét séméiologique. Rev Neurol (Paris) 1955;93(1):143–149. [PubMed] [Google Scholar]
  19. Gee J. C., Reivich M., Bajcsy R. Elastically deforming 3D atlas to match anatomical brain images. J Comput Assist Tomogr. 1993 Mar-Apr;17(2):225–236. doi: 10.1097/00004728-199303000-00011. [DOI] [PubMed] [Google Scholar]
  20. Ghika J., Bogousslavsky J., Henderson J., Maeder P., Regli F. The "jerky dystonic unsteady hand": a delayed motor syndrome in posterior thalamic infarctions. J Neurol. 1994 Aug;241(9):537–542. doi: 10.1007/BF00873516. [DOI] [PubMed] [Google Scholar]
  21. Gibb W. R., Lees A. J., Marsden C. D. Pathological report of four patients presenting with cranial dystonias. Mov Disord. 1988;3(3):211–221. doi: 10.1002/mds.870030305. [DOI] [PubMed] [Google Scholar]
  22. Greitz T., Bohm C., Holte S., Eriksson L. A computerized brain atlas: construction, anatomical content, and some applications. J Comput Assist Tomogr. 1991 Jan-Feb;15(1):26–38. [PubMed] [Google Scholar]
  23. Grimes J. D., Hassan M. N., Quarrington A. M., D'Alton J. Delayed-onset posthemiplegic dystonia: CT demonstration of basal ganglia pathology. Neurology. 1982 Sep;32(9):1033–1035. doi: 10.1212/wnl.32.9.1033. [DOI] [PubMed] [Google Scholar]
  24. Hirai T., Jones E. G. A new parcellation of the human thalamus on the basis of histochemical staining. Brain Res Brain Res Rev. 1989 Jan-Mar;14(1):1–34. doi: 10.1016/0165-0173(89)90007-6. [DOI] [PubMed] [Google Scholar]
  25. Kato M., Kimura M. Effects of reversible blockade of basal ganglia on a voluntary arm movement. J Neurophysiol. 1992 Nov;68(5):1516–1534. doi: 10.1152/jn.1992.68.5.1516. [DOI] [PubMed] [Google Scholar]
  26. Künzle H. Bilateral projections from precentral motor cortex to the putamen and other parts of the basal ganglia. An autoradiographic study in Macaca fascicularis. Brain Res. 1975 May 2;88(2):195–209. doi: 10.1016/0006-8993(75)90384-4. [DOI] [PubMed] [Google Scholar]
  27. Lee M. S., Marsden C. D. Movement disorders following lesions of the thalamus or subthalamic region. Mov Disord. 1994 Sep;9(5):493–507. doi: 10.1002/mds.870090502. [DOI] [PubMed] [Google Scholar]
  28. 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]
  29. 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]
  30. Messimy R., Diebler C., Metzger J. Dystonie de torsion du membre supérieur gauche probablement consécutive a un traumatisme cranien. Calcification de la tête du noyau caudé droit découverte à l'examen tomodensitométrique. Rev Neurol (Paris) 1977 Mar;133(3):199–206. [PubMed] [Google Scholar]
  31. Milhorat T. H. Experimental myoclonus of thalamic origin. Arch Neurol. 1967 Oct;17(4):365–378. doi: 10.1001/archneur.1967.00470280031004. [DOI] [PubMed] [Google Scholar]
  32. Mink J. W., Thach W. T. Basal ganglia motor control. III. Pallidal ablation: normal reaction time, muscle cocontraction, and slow movement. J Neurophysiol. 1991 Feb;65(2):330–351. doi: 10.1152/jn.1991.65.2.330. [DOI] [PubMed] [Google Scholar]
  33. Mitchell I. J., Luquin R., Boyce S., Clarke C. E., Robertson R. G., Sambrook M. A., Crossman A. R. Neural mechanisms of dystonia: evidence from a 2-deoxyglucose uptake study in a primate model of dopamine agonist-induced dystonia. Mov Disord. 1990;5(1):49–54. doi: 10.1002/mds.870050113. [DOI] [PubMed] [Google Scholar]
  34. Narbona J., Obeso J. A., Tuñon T., Martinez-Lage J. M., Marsden C. D. Hemi-dystonia secondary to localised basal ganglia tumour. J Neurol Neurosurg Psychiatry. 1984 Jul;47(7):704–709. doi: 10.1136/jnnp.47.7.704. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Niemann K., Naujokat C., Pohl G., Wollner C., von Keyserlingk D. Verification of the Schaltenbrand and Wahren stereotactic atlas. Acta Neurochir (Wien) 1994;129(1-2):72–81. doi: 10.1007/BF01400876. [DOI] [PubMed] [Google Scholar]
  36. Obeso J. A., Rothwell J. C., Lang A. E., Marsden C. D. Myoclonic dystonia. Neurology. 1983 Jul;33(7):825–830. doi: 10.1212/wnl.33.7.825. [DOI] [PubMed] [Google Scholar]
  37. Ohye C., Shibazaki T., Hirai T., Wada H., Hirato M., Kawashima Y. Further physiological observations on the ventralis intermedius neurons in the human thalamus. J Neurophysiol. 1989 Mar;61(3):488–500. doi: 10.1152/jn.1989.61.3.488. [DOI] [PubMed] [Google Scholar]
  38. Oppenheimer D. R. A case of striatal hemiplegia. J Neurol Neurosurg Psychiatry. 1967 Apr;30(2):134–139. doi: 10.1136/jnnp.30.2.134. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Parent A. Extrinsic connections of the basal ganglia. Trends Neurosci. 1990 Jul;13(7):254–258. doi: 10.1016/0166-2236(90)90105-j. [DOI] [PubMed] [Google Scholar]
  40. Percheron G., François C., Talbi B., Meder J. F., Fenelon G., Yelnik J. The primate motor thalamus analysed with reference to subcortical afferent territories. Stereotact Funct Neurosurg. 1993;60(1-3):32–41. doi: 10.1159/000100588. [DOI] [PubMed] [Google Scholar]
  41. Percheron G., Yelnik J., François C., Fénelon G., Talbi B. Analyse informationnelle du système lié aux ganglions de la base. Rev Neurol (Paris) 1994 Aug-Sep;150(8-9):614–626. [PubMed] [Google Scholar]
  42. 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]
  43. Plant G. T., Kermode A. G., du Boulay E. P., McDonald W. I. Spasmodic torticollis due to a midbrain lesion in a case of multiple sclerosis. Mov Disord. 1989;4(4):359–362. doi: 10.1002/mds.870040413. [DOI] [PubMed] [Google Scholar]
  44. Scott B. L., Jankovic J. Delayed-onset progressive movement disorders after static brain lesions. Neurology. 1996 Jan;46(1):68–74. doi: 10.1212/wnl.46.1.68. [DOI] [PubMed] [Google Scholar]
  45. Sellal F., Hirsch E., Barth P., Blond S., Marescaux C. A case of symptomatic hemidystonia improved by ventroposterolateral thalamic electrostimulation. Mov Disord. 1993 Oct;8(4):515–518. doi: 10.1002/mds.870080418. [DOI] [PubMed] [Google Scholar]
  46. Tasker R. R., Doorly T., Yamashiro K. Thalamotomy in generalized dystonia. Adv Neurol. 1988;50:615–631. [PubMed] [Google Scholar]
  47. Toga A. W. A digital three-dimensional atlas of structure/function relationships. J Chem Neuroanat. 1991 Sep-Oct;4(5):313–318. doi: 10.1016/0891-0618(91)90039-f. [DOI] [PubMed] [Google Scholar]
  48. Villemure J. G., Marchand E., Peters T., Leroux G., Olivier A. Magnetic resonance imaging stereotaxy: recognition and utilization of the commissures. Appl Neurophysiol. 1987;50(1-6):57–62. doi: 10.1159/000100685. [DOI] [PubMed] [Google Scholar]
  49. Yoshida M. Creation of a three-dimensional atlas by interpolation from Schaltenbrand-Bailey's atlas. Appl Neurophysiol. 1987;50(1-6):45–48. doi: 10.1159/000100682. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES