Nakayasu H, Sue S, Takahashi K, Hori T, Hokama Y
Department of Neurology, Misasa-onsen National Hospital.
Rinsho Shinkeigaku. 1991 May;31(5):550-3.
A 42-year-old woman developed an abrupt onset of severe headache, nausea, vomiting, unstable gait and numbness around the right side of her mouth and in her right hand. Neurological examination revealed bilateral pyramidal tract signs and hypesthesia of her right palmar tip and the right side of her mouth. However, pain and temperature sensibility was preserved. Cerebrospinal fluid was clear and colorless. CT scan showed an enhancing mass in the prepontine cistern compressing the pontine base. Vertebral angiography revealed irregular narrowing of bilateral vertebral arteries (string sign) proximal to a fusiform aneurysm on the entire length of the basilar artery. MRI showed double lumina in the wall of the aneurysm. The medial lemniscus conducts the discriminatory tactile and the deep sensory impulses from the extremities. The ventral ascending tract of the trigeminal nerve conducts the discriminatory tactile sensory impulses from the face. These two tracts lie close together in the pontine tegmentum, which is also a watershed area of the paramedian branches and circumferential branches of the basilar artery. We suggest that in this case the dissecting aneurysm caused ischemia of these two tracts in the left pontine tegmentum, presenting right cheiro-oral syndrome.
一名42岁女性突然出现严重头痛、恶心、呕吐、步态不稳以及右侧口角周围和右手麻木。神经系统检查发现双侧锥体束征以及右手掌尖和右侧口角感觉减退。然而，痛觉和温度觉保留。脑脊液清晰无色。CT扫描显示脑桥前池有一强化肿块压迫脑桥基底部。椎动脉血管造影显示双侧椎动脉在基底动脉全程梭形动脉瘤近端不规则狭窄（串珠征）。MRI显示动脉瘤壁有双腔。内侧丘系传导来自四肢的辨别性触觉和深部感觉冲动。三叉神经腹侧升支传导来自面部的辨别性触觉感觉冲动。这两条束在脑桥被盖部紧密相邻，而脑桥被盖部也是基底动脉旁正中分支和环行分支的分水岭区域。我们认为在该病例中，夹层动脉瘤导致左侧脑桥被盖部这两条束缺血，从而出现右侧口手综合征。
