Songu Murat, Can Nazan, Gelal Fazil
Department of Otorhinolaryngology, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey.
Ear Nose Throat J. 2013 Jan;92(1):E19-21. doi: 10.1177/014556131309200122.
The precise location of the sneeze center in the human brain has not been definitively identified. The aim of this report is to contribute to the effort to detect its location. We report the case of a 13-year-old boy who presented to our outpatient clinic for evaluation of an inability to sneeze. In an attempt to trigger the afferent (nasal) phase of the sneeze reflex, we first applied a cotton swab and later a silver nitrate stick to the patient's nasal mucosa. Once that was accomplished, we observed that the patient could not complete the efferent (expiratory) phase of the sneeze reflex, and thus he did not sneeze. Cranial magnetic resonance imaging (MRI) revealed that his cerebellar tonsils extended approximately 10 mm inferiorly through the foramen magnum, which represented a type I Arnold-Chiari malformation. The tonsils were noted to have compressed the posterolateral portion of the medulla oblongata. At follow-up 21 months later, we noted that the patient was able to sneeze spontaneously as well as with nasal stimulation. Repeat MRI revealed that the Arnold-Chiari malformation had undergone a spontaneous partial regression, which resulted in relief of the compression of the medulla oblongata. We believe that the patient's earlier inability to sneeze might have been attributable to the compression of the medulla oblongata by the cerebellar tonsils and that the site of the compression might represent the location of his sneeze center.
人类大脑中喷嚏中枢的确切位置尚未得到明确确认。本报告的目的是为探测其位置的工作做出贡献。我们报告一例13岁男孩的病例，他因无法打喷嚏前来我院门诊评估。为了触发喷嚏反射的传入（鼻腔）阶段，我们首先用棉签，之后用硝酸银棒接触患者的鼻黏膜。完成这一步骤后，我们观察到患者无法完成喷嚏反射的传出（呼气）阶段，因此他没有打喷嚏。头颅磁共振成像（MRI）显示，他的小脑扁桃体经枕骨大孔向下延伸约10毫米，这代表I型阿诺德 - 奇亚里畸形。注意到扁桃体压迫了延髓的后外侧部分。在21个月后的随访中，我们注意到患者能够自发打喷嚏以及在鼻腔受到刺激时打喷嚏。重复MRI显示，阿诺德 - 奇亚里畸形已自发部分消退，从而缓解了对延髓的压迫。我们认为，患者早期无法打喷嚏可能归因于小脑扁桃体对延髓的压迫，而压迫部位可能代表他的喷嚏中枢位置。
