Peña Alonso, Owler Brian K, Fryer Tim D, Minhas Pawan, Czosnyka Marek, Crawford Peter J, Pickard John D
Academic Neurosurgery Unit, Wolfson Brain Imaging Centre, Addenbrooke's Hospital, Department of Engineering, University of Cambridge, United Kingdom.
J Neuroimaging. 2002 Oct;12(4):360-7. doi: 10.1111/j.1552-6569.2002.tb00145.x.
The authors present a patient who developed transient hemispatial neglect following surgical drainage of a large right frontotemporal arachnoid cyst. As symptoms evolved in parallel with brain shift over the subsequent months, the authors hypothesized that the disorder was associated with the appearance of mechanical stresses in the cerebral mantle.
To map tissue stress at the various stages of deformation, a finite element computer simulation was conducted on the basis of computed tomography scans of the patient.
The authors' results demonstrate substantial shear and compressive stress concentrations in the parietal lobe, a region commonly associated with neglect, and where positron emission tomography confirmed hypoperfusion in this patient. Treatment with combined ventricular-peritoneal and cystoperitoneal shunts was accompanied by clinical recovery and improvement of right parietal lobe cerebral blood flow.
The authors conclude that brain deformation was a contributing factor in the reversible neglect syndrome by compromising the normal flow of blood and/or the deactivation of subcortical circuits of the parietal lobe.
作者报告了一名患者，该患者在右侧额颞部大型蛛网膜囊肿手术引流后出现短暂性半侧空间忽视。由于症状在随后几个月与脑移位同步演变，作者推测该病症与大脑皮质出现机械应力有关。
为了绘制变形各阶段的组织应力，基于患者的计算机断层扫描进行了有限元计算机模拟。
作者的结果表明，顶叶存在大量剪切应力和压缩应力集中，该区域通常与忽视相关，并且正电子发射断层扫描证实该患者存在灌注不足。联合脑室 - 腹腔分流术和囊肿 - 腹腔分流术治疗后，患者临床症状恢复，右侧顶叶脑血流量改善。
作者得出结论，脑变形通过损害正常血流和/或顶叶皮质下回路失活，是导致可逆性忽视综合征的一个因素。
