Toma Keiichiro, Taguchi Keiko, Ikeda Akio, Nishinaka Kazuto, Udaka Fukashi, Kameyama Masakuni
Department of Neurology, Sumitomo Hospital.
Rinsho Shinkeigaku. 2012;52(9):651-5. doi: 10.5692/clinicalneurol.52.651.
This report presents the case of an 83-year-old female with a tumor in the right temporal lobe. She experienced various epileptic visual auras including visual perseveration. Visual perseveration is classified into polyopia and palinopsia. Epileptic visual perseveration is a rare phenomenon, and the mechanism has not been fully explained. MRI revealed a tumor in the right temporal lobe with edema in the occipital white matter. To reveal mechanisms of epileptic polyopia and palinopsia, we recorded EEG and (123)I-IMP-SPECT when she experienced epileptic attacks. EEG showed epileptic discharges beginning at the occipital area, which spread to the temporal and parietal areas. During the EEG recording, the main symptom was an unformed hallucination. SPECT showed that blood flow increased in the right medial temporal and parietal lobes and, to a slightly lesser extent, in the right occipito-temporal area when the polyopia and palinopsia frequently appeared. Involvement of the multiple foci may have caused the different kinds of visual symptoms. The medial temporal and parietal areas were likely responsible for polyopia and palinopsia at least for this patient.
本报告介绍了一名83岁女性患者，其右侧颞叶有一个肿瘤。她经历了各种癫痫性视觉先兆，包括视觉滞留。视觉滞留分为视物显多症和视觉重复症。癫痫性视觉滞留是一种罕见现象，其机制尚未完全阐明。磁共振成像（MRI）显示右侧颞叶有一个肿瘤，枕叶白质有水肿。为了揭示癫痫性视物显多症和视觉重复症的机制，我们在她癫痫发作时记录了脑电图（EEG）和碘-123异丁基苄胍单光子发射计算机断层扫描（(123)I-IMP-SPECT）。脑电图显示癫痫放电始于枕叶区域，随后扩散至颞叶和顶叶区域。在脑电图记录期间，主要症状是不成形的幻觉。单光子发射计算机断层扫描显示，当视物显多症和视觉重复症频繁出现时，右侧颞叶内侧和顶叶的血流增加，右侧枕颞区域血流增加程度稍小。多个病灶的累及可能导致了不同类型的视觉症状。至少对该患者而言，颞叶内侧和顶叶区域可能是导致视物显多症和视觉重复症的原因。
