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Síndrome do andar superior da cápsula interna. Hemiplegia sensitivo-motora capsular

Since Türck (1859) many authors have been interested in the passage of the sensitive fibers through the internal capsule. Even today the sensitive pathways are a very discussed subject particularly at the level of the internal capsule. In this paper the A. exposes the ideas about the possibility of the existence of sensitive fibers in the capsule. The A. reports the opinions about sensitive disturbances in the lesions of the interna capsule taken from the french writers (Charcot, Dejerine, Long, Marie, etc.) who were based on anatomical and clinical facts; of the english writers (Horsley, Sherrington, Grünbaum, Beevor, Wilson, etc.) who were based in experimentation; of the german authors (Lewandowski, Oppenheim, Monakow) and the american (Grinker). The internal capsule is a diedric formation formed by the jonction of two plans: the anterior limb and the posterior limb. By the superior part (superior floor) of the posterior limb run the fibers wich arise from the thalamus (thalamic-parietal fibers), fibers wich are between the lenticular nucleus and the thalamus (extrapyramdial fibers) and the fibers wich descend to the cerebral peduncle (pyramidal fibers). In the inferior part (inferior floor) of the posterior limb there are only pyramidal fibers. The A. studies the Dejerine-Roussy's syndrome, the thalamic states (Austregesilo and Colares) and the capsular hemiplegia, in the clinical and experimental point of view. The A. shows that sensitive troubles does not exist in the paralysis caused by lesion of the inferior floor of the posterior limb of internal capsula. Finally the A. stuties the syndrome of the superior floor of the internal capsule, i. e., sensitive-motor capsular hemiplegia. The A. presents two cases of hemiplegia accompanied with hemianesthesia with showed in the anatomical study a lesion of the superior floor of the internal capsule's posterior limb. The thalamus was normal in both cases. The A. calls attention to the difference between capsular and thalamic hand. In the first one there is contracture in flexion with supination or pronation. In the second case the fingers are distended with choreo-athetotic movements Thalamic syndrome paralysis is hypotonic and improves quickly; the capsular paralysis is persistent and with increased tonus. In the capsular hemiplegia very seldom appears spontaneous pains as well as Foerster's hiperpathia, over-reaction (Head). These phenomena are very common in the thalamic syndrome.


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