Lehmann G, Bremond J, Rabaud C, Paillas J E
Neurochirurgie. 1975 Jan-Feb;21(1):55-79.
The authors report 90 cases of space occupying lesions originating in the occipital lobe, including 58 primary (26 malignant gliomas, II "benign" gliomas, 19 meningiomas, I sarcoma nad I hémangioblastoma (and 32 secondary masses (i. e. 16 metastatic tumors, 15 abcesses and I hydatid cyst). The onset of clinical features was progressive (gradual increase of intracranial pressure : 59 p. 100) rather than acute (41 p. 100 mostly as a visual (II) or a non visual (10) epileptic seizure). The time elapsed between the first symptom and the surgical procedure in any case appeared to be much shorter than in masses with other hemispheric localisation. This is thought to be due to the precocity and the intensity of the increased intracranial pressure, in relation to the blocage of posterior venous drainage. Increased intracranial pressure : only 7,7 p. 100 of the patient were free of IIP. Fundal changes are of little value in excluding this finding since no less than 3 months of evolution are necessary for their appearence. Visual disturbances consisted of acute obscurations (7.7 p. 100), controlateral deviations of head and eyes (3.3 p. 100) and visual field defects = 10 p. 100 of the patients were comatose and unable to be examined, 16.6 p. 100 had normal visual field. All the others had visual field defects wich could be evaluated by campimetric examination in only 26.6 p. 100. These included 14 hemiopias (7 without macular sparing) and 10 quadranopsia, always with incongruence (4 superior and 6 inferior). When the mass was strictly occipital, the same disparity was observed. Finally these visual field defects appeared to be variable and could well recover after surgery. Visual hallucinations were mostly of elementary type (21 p. 100) and always controlateral in cases of strictly occipital lesions. Elaborate hallucinations were rare (2 patients with extensive lesions). 8.8 p. 100 suffered from visual illusions wich always were related to large and right-sided masses. Disturbances of higher functions : Alexia was seen in 33 p. 100 of the left-sided masses (24 p. 100 "agraphic", 9 p. 100 "pure word blindness") Space agnosias of different type was found in 10 p. 100 of the patients, sometimes with purely occipital tumors.
作者报告了90例起源于枕叶的占位性病变，其中包括58例原发性病变（26例恶性胶质瘤、2例“良性”胶质瘤、19例脑膜瘤、1例肉瘤和1例成血管细胞瘤）以及32例继发性病变（即16例转移瘤、15例脓肿和1例包虫囊肿）。临床特征的起病多为渐进性（颅内压逐渐升高：占100例中的59例）而非急性（占100例中的41例，多表现为视觉性癫痫发作（11例）或非视觉性癫痫发作（10例））。在任何情况下，从首发症状到手术的时间间隔似乎都比其他半球定位的肿块要短得多。这被认为是由于颅内压升高出现较早且程度较重，与后静脉引流受阻有关。颅内压升高：仅7.7%的患者没有颅内压升高。眼底改变对于排除这一发现价值不大，因为其出现至少需要3个月的病程。视觉障碍包括急性视力模糊（7.7%）、头眼向对侧偏斜（3.3%）和视野缺损（10%）。10%的患者昏迷无法检查，16.6%的患者视野正常。其他所有患者都有视野缺损，其中仅26.6%可通过视野计检查进行评估。这些包括14例偏盲（7例无黄斑回避）和10例象限盲，均为不一致性（4例上象限盲和6例下象限盲）。当肿块严格位于枕叶时，也观察到了同样的差异。最后，这些视野缺损似乎是可变的，术后可能会很好地恢复。视幻觉大多为基本型（21%），在严格位于枕叶的病变中总是对侧性的。复杂视幻觉很少见（2例广泛病变患者）。8.8%的患者出现视错觉，总是与较大的右侧肿块有关。高级功能障碍：左侧肿块患者中33%出现失读症（24%为“失写性失读”，9%为“纯词盲”）。10%的患者发现有不同类型的空间失认症，有时是单纯枕叶肿瘤患者。
