Hantson P, Wittebole X, Rombaux P, Cosnard G
Department of Intensive Care, Université catholique de Louvain, Cliniques St-Luc, Brussels, Belgium.
B-ENT. 2012;8(2):131-4.
A 32-year-old woman developed altered consciousness two days after initial symptoms of acute otitis media, with purulent discharge from the right ear. She was quadriplegic, with spontaneous eye opening, mild neck stiffness, and lacking vestibular-ocular reflexes.
Upon admission, the patient was subjected to brain computed tomography (CT), magnetic resonance imaging (MRI), and lumbar puncture.
CT was consistent with pansinusitis, right middle ear otitis, mastoiditis, and sphenoiditis. No brainstem lesion was evident; brain MRI demonstrated ischemic and secondary hemorrhagic lesions in the pons and cerebral peduncles. The dura mater in the petroclival space was intensely inflamed, and likely responsible for reduced basilar arterial blood flow. Lumbar puncture yielded clear cerebrospinal fluid; gram stain examination was negative and culture remained sterile. Streptococcus pneumoniae and Haemophilus influenzae were cultured from the purulent ear discharge.
The final diagnosis was locked-in syndrome consecutive to inflammatory changes compressing the basilar artery.
一名32岁女性在急性中耳炎初发症状出现两天后出现意识改变，右耳有脓性分泌物。她四肢瘫痪，能自主睁眼，颈部轻度僵硬，缺乏前庭眼反射。
入院时，对患者进行了脑部计算机断层扫描（CT）、磁共振成像（MRI）和腰椎穿刺。
CT显示全鼻窦炎、右中耳中耳炎、乳突炎和蝶窦炎。未发现明显的脑干病变；脑部MRI显示脑桥和脑 peduncles 有缺血性和继发性出血性病变。岩斜间隙的硬脑膜严重发炎，可能是基底动脉血流减少的原因。腰椎穿刺获得清澈的脑脊液；革兰氏染色检查为阴性，培养仍无菌。从脓性耳分泌物中培养出肺炎链球菌和流感嗜血杆菌。
最终诊断为因炎症改变压迫基底动脉导致的闭锁综合征。
