Ohta Hirotsugu, Genmoto Tetsuya, Yokota Akira
Department of Neurosurgery, Chikuhou Rosai Hospital, 633 Benbun, Honami-machi, Kaho-gun, Fukaoka 820-0088, Japan.
No To Shinkei. 2004 Feb;56(2):169-72.
Spontaneous intracranial hypotension (SIH) is a rare disease which is associated with variety of symptoms and signs including cranial neuropathies. Though diplopia occurred reportedly in about one fourth of SIH cases, trochlear nerve palsy has been reported only one case in the literature. A 71-year-old previously healthy male developed postural headache and nausea. After 15 days, he began to have diplopia caused by right trochlear nerve palsy. He consulted our hospital 2 months later because only diplopia was not recovered. Magnetic resonance imaging (MRI) showed bilateral thin chronic subdural hematoma (CSDH), brain sagging and downward brain stem displacement, but not ischemic change in brain stem. We suspected SIH for right trochlear nerve palsy, and he had symptomatic therapy. Two months later, he had burr hole surgery because of disturbance of consciousness and right hemiparesis due to progressive bilateral-CSDH. To say nothing of disturbance of consciousness and right hemiparesis, his trochlear nerve palsy was completely recovered after surgery at once. Follow-up MRI showed brain sagging and downward brain stem displacement were recovered.
自发性颅内低压（SIH）是一种罕见疾病，与包括颅神经病变在内的多种症状和体征相关。尽管据报道约四分之一的SIH病例会出现复视，但文献中仅报道过1例滑车神经麻痹。一名71岁既往健康的男性出现了体位性头痛和恶心。15天后，他开始出现由右侧滑车神经麻痹引起的复视。2个月后，由于仅复视未恢复，他前来我院就诊。磁共振成像（MRI）显示双侧慢性硬膜下血肿（CSDH）较薄、脑下垂和脑干向下移位，但脑干无缺血改变。我们怀疑右侧滑车神经麻痹为SIH所致，并对其进行了对症治疗。2个月后，由于进行性双侧CSDH导致意识障碍和右侧偏瘫，他接受了钻孔手术。术后，不仅意识障碍和右侧偏瘫得到改善，他的滑车神经麻痹也立即完全恢复。随访MRI显示脑下垂和脑干向下移位已恢复。
