Brain, Vol. 117, No. 4, 859-876, 1994
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research-article |
The behavioural and motor consequences of focal lesions of the basal ganglia in man
University Department of Clinical Neurology, Institute of Neurology and the National Hospital for Neurology and Neurosurgery London, UK
Correspondence to:
0Correspondence to: Professor C. D. Marsden, Institute of Neurology, Queen Square, London WC1N 3BG, UK
The behavioural and movement disorders reported in 240 patients described in the literature with lesions affecting the caudate nucleus, putamen and the globus pallidus (lentiform nucleus) have been analysed. Reports were classified into two groups: small or isolated lesions involving the said nuclei alone; and large lesions with additional involvement of the adjacent internal capsule and/or periventricular white matter. Amongst the 240 cases, dystonia was the most frequent movement disorder recorded (36%); chorea (8%) and parkinsonism (6%) or dystonia-parkinsonism (3%) were uncommon. The commonest behavioural disturbance was the syndrome of abulia (apathy with loss of initiative and of spontaneous thought and emotional responses) (13%); disinhibition was rare (4%). Confusion usually was associated with intracerebral haemorrhage and depression was a relatively non-specific finding. Aphasia was extremely rare with lesions confined to these basal ganglia structures. Lesions of the caudate nucleus rarely caused motor disordersbut were more likely to cause behavioural problems. Chorea has been described in only 6% of those with caudate lesions, and dystonia in only 9%. The most significant behavioural disturbance described in 28% of those with caudate lesions was the syndrome of abulia, sometimes alternating with disinhibition (11%). Lesions of the lentiform nuclei rarely caused abulia (10%) and did not produce disinhibition, but they commonly caused dystonia (49%), particularly when the putamen was involved (63%). Bilateral lesions of the lentiform nuclei, either of the globus pallidus or of the putamen, caused parkinsonism (19%) or dystonia-parkinsonism (6%) infrequently. The prominence of the behavioural disturbance of abulia with caudate lesions emphasizes the more complex cognitive role of this basal ganglia structure. The frequent occurrence of dystonia and less commonly of parkinsonism with lentiform lesions emphasize the motor roles of putamen and globus pallidus.
behavioural disorder; abulia; motor disorder; dystonia; basal ganglia lesions
Received December 22, 1993. Revised April 13, 1994. Accepted April 24, 1994.
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M Giroud, M Lemesle, G Madinier, T. Billiar, and R Dumas Unilateral lenticular infarcts: radiological and clinical syndromes, aetiology, and prognosis J. Neurol. Neurosurg. Psychiatry, November 1, 1997; 63(5): 611 - 615. [Abstract] [Full Text] [PDF]
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R. Levy, H. R. Friedman, L. Davachi, and P. S. Goldman-Rakic Differential Activation of the Caudate Nucleus in Primates Performing Spatial and Nonspatial Working Memory Tasks J. Neurosci., May 15, 1997; 17(10): 3870 - 3882. [Abstract] [Full Text] [PDF]
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J. S. Perlmutter, M. K. Stambuk, J. Markham, K. J. Black, L. McGee-Minnich, J. Jankovic, and S. M. Moerlein Decreased [18F]Spiperone Binding in Putamen in Idiopathic Focal Dystonia J. Neurosci., January 15, 1997; 17(2): 843 - 850. [Abstract] [Full Text] [PDF]
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F. M. Filloux Neuropathophysiology of Movement Disorders in Cerebral Palsy J Child Neurol, November 1, 1996; 11(1_suppl): S5 - S12. [Abstract] [PDF]
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M. R. Pranzatelli Topical Review: Antidyskinetic Drug Therapy for Pediatric Movement Disorders J Child Neurol, September 1, 1996; 11(5): 355 - 369. [Abstract] [PDF]
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S. F. Bucher, K. C. Seelos, R. C. Dodel, W. Paulus, M. Reiser, and W. H. Oertel Pallidal Lesions: Structural and Functional Magnetic Resonance Imaging Arch Neurol, July 1, 1996; 53(7): 682 - 686. [Abstract] [PDF]
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B. Zappacosta, D. Monza, C. Meoni, L. Austoni, P. Soliveri, C. Gellera, R. Alberti, M. Mantero, G. Penati, T. Caraceni, et al. Psychiatric Symptoms Do Not Correlate With Cognitive Decline, Motor Symptoms, or CAG Repeat Length in Huntington's Disease Arch Neurol, June 1, 1996; 53(6): 493 - 497. [Abstract] [PDF]
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H. C. Cromwell and K. C. Berridge Implementation of Action Sequences by a Neostriatal Site: A Lesion Mapping Study of Grooming Syntax J. Neurosci., May 15, 1996; 16(10): 3444 - 3458. [Abstract] [Full Text] [PDF]
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S. Lehericy, M. Vidailhet, D. Dormont, L. Pierot, J. Chiras, P. Mazetti, C. Marsault, and Y. Agid Striatopallidal and Thalamic Dystonia: A Magnetic Resonance Imaging Anatomoclinical Study Arch Neurol, March 1, 1996; 53(3): 241 - 250. [Abstract] [PDF]
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