Kronenburg Annick, Spliet Wim G, Broekman Marike, Robe Pierre
Department of Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands.
BMJ Case Rep. 2015 Apr 22;2015:bcr2014207018. doi: 10.1136/bcr-2014-207018.
We describe a case of a 48-year-old woman who underwent a resection of a tectal pilocytic astrocytoma complicated by a sequence of fluctuating consciousness, psychosis with complex hallucinations and lasting sleeping disturbances in which she vividly acts out her dreams. Based on the clinical and anatomical evidence of this case, we propose the term locus coeruleus syndrome to describe this association of iatrogenic symptoms. Along with those of the locus coeruleus, lesions of the dorsal raphe nucleus, ventral tegmentum, substantia nigra pars compacta, the superior colliculus and other peduncular lesions (such as peduncular hallucinosis) are involved in the regulation of sleep-wake/arousal, behaviour, sleeping disorders and rapid eye movement atonia. However, iatrogenic lesion of the locus coeruleus could explain the complications on all levels in our patient.
我们描述了一例48岁女性患者，她接受了顶盖毛细胞型星形细胞瘤切除术，术后出现一系列意识波动、伴有复杂幻觉的精神病症状以及持续的睡眠障碍，在睡眠障碍中她会生动地将梦境付诸行动。基于该病例的临床和解剖学证据，我们提出“蓝斑综合征”这一术语来描述这种医源性症状的组合。除了蓝斑病变外，中缝背核、腹侧被盖区、黑质致密部、上丘的病变以及其他脑脚病变（如脑脚幻觉症）都参与了睡眠-觉醒/唤醒、行为、睡眠障碍和快速眼动期肌张力缺失的调节。然而，蓝斑的医源性损伤可以解释我们这位患者出现的所有层面的并发症。
