Nishioka T, Kondo A, Nin K, Tashiro H, Ikai Y, Takahashi J
Department of Neurosurgery, Kitano Hospital, Osaka.
Neurol Med Chir (Tokyo). 1990;30(11 Spec No):904-7. doi: 10.2176/nmc.30.904.
A 69-year-old male presented with a 4-month episode of tonic seizures of the right arm and leg. Neurological examination revealed no abnormal findings. In the electroencephalogram, sharp wave trains were seen dominantly in the left frontal region. Computed tomography scans showed a spotty hyperdense lesion in the left insular area with minimal enhancement. Left carotid angiogram demonstrated no abnormalities in the arterial and capillary phases. In the venous phase, however, a varicose dilatation of the posterior insular vein was found, which was also noticed in the delayed phase. Magnetic resonance T1-weighted images failed to detect the lesion, but T2-weighted images showed a slight signal focus in the same area. After administration of 300 mg of phenytoin daily, the frequency of attacks markedly decreased and the patient was kept under close outpatient observation.
一名69岁男性出现右臂和右腿强直性发作4个月。神经系统检查未发现异常。脑电图显示，尖锐波群主要出现在左侧额叶区域。计算机断层扫描显示左侧岛叶区域有一个斑点状高密度病变，增强不明显。左侧颈动脉血管造影显示动脉期和毛细血管期无异常。然而，在静脉期发现岛叶后静脉曲张扩张，延迟期也可见。磁共振T1加权图像未能检测到病变，但T2加权图像显示同一区域有轻微信号灶。每天服用300毫克苯妥英钠后，发作频率明显降低，患者在门诊接受密切观察。
