Department of Otolaryngology, Catholic Cardinal Tien Hospital, Fu-Jen Catholic University, Taipei, Taiwan.
Otol Neurotol. 2011 Oct;32(8):1329-35. doi: 10.1097/MAO.0b013e31822e5ba7.
The fourth ventricle encompasses many vital structures including the brainstem as its floor and the cerebellum as its lateral wall and roof. Therefore, lesions affecting the fourth ventricle may present as cerebellar or brainstem manifestations. Herein, we presented our experience in the diagnosis of disorders affecting the fourth ventricle during the past 15 years.
Retrospective study.
University hospital.
From September 1995 to August 2010, 24,838 patients with vertigo/dizziness visited the clinic. Of them, 13 patients (0.5%) had tumor/stroke affecting the fourth ventricle.
All patients underwent a battery of audiovestibular function test.
All patients had vertigo (100%) and then ataxia (92%) and nausea/vomiting (85%). Eight patients (68%) displayed persistent nystagmus. Most (>75%) patients showed central signs in electronystagmographic recordings and abnormal caloric coupled with visual suppression test. Three patients underwent both ocular and cervical vestibular-evoked myogenic potential tests, and abnormal results were noted in all 3 patients indicating a brainstem involvement. However, magnetic resonance imaging failed to demonstrate brainstem lesion in these 3 patients. Final diagnoses consisted of the following: cavernoma, n = 3; metastatic cancer, n = 3; astrocytoma, n = 2; meningioma, n = 2; epidermoid cyst, n = 1; ependymoma, n = 1; and lymphoma, n = 1. The prognosis was poor as 10 patients (77%) died within 2 years.
When a vertiginous patient displayed ataxia, persistent vomiting, and persistent nystagmus, lesion affecting the fourth ventricle should be kept in mind because its prognosis is poor. Abnormal results in electronystagmography and in ocular and cervical vestibular-evoked myogenic potentials may serve as a supplementary to magnetic resonance imaging to delineate the involvement of the lesion.
第四脑室包含许多重要结构，包括脑干作为其底部和小脑作为其外侧壁和顶部。因此，影响第四脑室的病变可能表现为小脑或脑干表现。在此，我们介绍了我们在过去 15 年中诊断影响第四脑室疾病的经验。
回顾性研究。
大学医院。
从 1995 年 9 月至 2010 年 8 月，有 24838 名眩晕/头晕患者就诊。其中，有 13 名患者（0.5%）因肿瘤/中风影响第四脑室。
所有患者均进行了一系列听觉前庭功能测试。
所有患者均有眩晕（100%），然后有共济失调（92%）和恶心/呕吐（85%）。8 名患者（68%）表现出持续的眼球震颤。大多数（>75%）患者在眼震电图记录中显示中枢体征和异常的冷热联合视觉抑制试验。3 名患者同时进行了眼和颈前庭诱发肌源性电位测试，所有 3 名患者的结果均异常，提示脑干受累。然而，这 3 名患者的磁共振成像未能显示脑干病变。最终诊断包括以下内容：海绵状血管瘤，n = 3；转移性癌，n = 3；星形细胞瘤，n = 2；脑膜瘤，n = 2；表皮样囊肿，n = 1；室管膜瘤，n = 1；和淋巴瘤，n = 1。预后较差，10 名患者（77%）在 2 年内死亡。
当眩晕患者出现共济失调、持续呕吐和持续眼球震颤时，应考虑第四脑室病变，因为其预后较差。眼震电图和眼颈前庭诱发肌源性电位异常可作为磁共振成像的补充，以描绘病变的受累情况。
