Sattelmeyer V M, Vernet O, Janzer R, de Tribolet N
Department of Neurosurgery, Centre Hospitalier Universitaire Vaudois, CH-1011 Lausanne, Switzerland.
J Clin Neurosci. 1999 May;6(3):259-61. doi: 10.1016/s0967-5868(99)90518-0.
A rare case of neurosarcoidosis presenting as an isolated quadrigeminal plate mass without systemic manifestation of this disease is reported. This 26-year-old man presented with symptoms of acute intracranial hypertension including headache, morning vomiting as well as a right homonymous hemianopsia. Magnetic resonance imaging (MRI) showed an expansive tectal mass causing hydrocephalus secondary to an aqueductal obstruction. An external ventricular drainage was inserted and the mass, postulated to be a glioma, was removed through an occipital transtentorial craniotomy. Histopathological examination revealed numerous sarcoid granulomas. Postoperative course was relevant for bilateral hypoacusis and tinnitus, blurred vision, bilateral palpebral ptosis and bilateral internuclear ophthalmoplegia. Chest X-ray was normal. Postoperative thoracic computed tomography (CT) scan showed mediastinal adenopathies. Lung function tests were normal. Angiotensin converting enzyme (ACE) cerebrospinal fluid (CSF) blood ratio was normal. Postoperative treatment and follow-up included corticosteroids, serial lung function tests and cerebral MRI. Neurosarcoidosis may present with protean clinical manifestations and unusual radiological features. This rare diagnosis has to be kept in mind when facing isolated intracerebral mass lesions.
报告了一例罕见的神经结节病，表现为孤立的四叠体板肿块，而无该疾病的全身表现。这名26岁男性出现急性颅内高压症状，包括头痛、晨起呕吐以及右侧同向性偏盲。磁共振成像（MRI）显示一个扩张性的顶盖肿块，继发导水管阻塞导致脑积水。插入了外部脑室引流管，并通过枕下经小脑幕开颅手术切除了推测为胶质瘤的肿块。组织病理学检查发现大量结节病肉芽肿。术后病程出现双侧听力减退和耳鸣、视力模糊、双侧眼睑下垂和双侧核间性眼肌麻痹。胸部X线检查正常。术后胸部计算机断层扫描（CT）显示纵隔淋巴结肿大。肺功能测试正常。血管紧张素转换酶（ACE）脑脊液（CSF）与血液的比值正常。术后治疗和随访包括使用皮质类固醇、系列肺功能测试和脑部MRI。神经结节病可能呈现出多种多样的临床表现和不寻常的放射学特征。面对孤立的脑内肿块病变时，必须考虑到这种罕见的诊断。
