Touge T, Takeuchi H, Yamada A, Miki H, Nishioka M
Third Department of Internal Medicine, Kagawa Medical School.
Rinsho Shinkeigaku. 1990 Aug;30(8):894-7.
A 63-year-old man was admitted to the hospital complaining that all objects in his vision suddenly appeared small. Examination on admission revealed amnesia of recent events, recognition memory deficits, emotional disturbance, right upper quadrantanopsia and micropsia. The patient was diagnosed as posterior cerebral artery territory infarction based on brain CT scan and MRI findings which showed an ischemic lesion involving the left occipital lobe and hippocampus. We regarded the quadrantanopsia to have originated in the occipital lobe lesion and memory and emotional disturbances to have originated in the hippocampal lesion. After admission, micropsia and disturbances of memory and emotion improved within a month, but the quadrantanopsia did not recover. A comparison of the 25th and 2nd day brain CT scans indicated that the low density of the ischemic lesion near the hippocampus had become less clear and smaller. These findings suggest that the pathogenesis of micropsia in this case was a visual perceptional abnormality due to edematous change in the structures near the hippocampus. Cases of occipital artery territory infarction with micropsia, disturbances of memory and emotion, and quadrantanopsia appear to be rare, but micropsia may be overlooked since it is often masked by disturbance of memory or emotion.
一名63岁男性因视物突然变小入院。入院检查发现近期事件失忆、识别记忆缺陷、情绪障碍、右上象限盲和视物显小症。根据脑部CT扫描和MRI结果显示左侧枕叶和海马区存在缺血性病变，该患者被诊断为大脑后动脉供血区梗死。我们认为象限盲源于枕叶病变，而记忆和情绪障碍源于海马区病变。入院后，视物显小症以及记忆和情绪障碍在一个月内有所改善，但象限盲未恢复。第25天与第2天的脑部CT扫描对比显示，海马区附近缺血性病变的低密度影变得不那么清晰且范围缩小。这些发现提示，该病例中视物显小症的发病机制是海马区附近结构的水肿变化导致的视觉感知异常。枕动脉供血区梗死伴视物显小症、记忆和情绪障碍以及象限盲的病例似乎较为罕见，但视物显小症可能因常被记忆或情绪障碍掩盖而被忽视。
