每日一题_2023.09.20

A 55-year-old woman has received treatment for years to manage a chronic, progressive dis- ease. Since her mid-40s the patient has had difficulty initiating movements. She has a shuffling gait, an expressionless face, and tremor in her hands and fingers at rest. Over the years she has tried many medications but with little relief of her symptoms, and instead has experienced severe adverse effects. She is referred for possible ablation surgery. The neurosurgeon explains the different pathways involved in initiation and inhibition of movement, the foundation of her disease. The neurosurgeon explains that by nullifying or accentuating some of the pathways, some of her symptoms may be alleviated. The introduction of an ablative lesion into which structure labeled in the image would be expected to improve this patient’s bradykinesia?

一名55岁女性多年来一直在接受治疗，以控制慢性进行性疾病。从她45岁左右开始，病人开始活动就有困难。她步履蹒跚，面无表情，手和手指在休息时都在颤抖。多年来，她尝试了多种药物治疗，但症状几乎没有缓解，反而出现了严重的不良反应。她被转诊接受可能的消融手术。神经外科医生解释了启动和抑制运动的不同途径，这是她疾病的基础。神经外科医生解释说，通过消除或强化某些通路，她的一些症状可能会得到缓解。在图像中标记的结构中引入消融病变有望改善该患者的运动迟缓?

(A) A

(B) B

(C) C

(D) D

(E) E

答案解析：

这个问题中的病人患有难治性帕金森病(PD)。在这种疾病中，苍白球内部节对丘脑腹外侧核产生过度抑制，使患者难以进行运动(运动迟缓)。正常情况下，来自黑质的多巴胺能神经元诱导纹状体神经元抑制苍白球，从而解除对丘脑的抑制。由于PD患者黑质多巴胺信号减少，该通路无效。消融部分苍白球内节(苍白球切断术)可减轻其对丘脑的强直抑制作用，改善患者的帕金森样症状。请注意，PD的一线治疗是药物治疗，最典型的是使用左旋多巴，左旋多巴在大脑中转化为多巴胺。

正确答案：A