Serlin Yonatan, Benifla Mony, Shelef Ilan
The Laboratory for Experimental Neurosurgery, Department of Physiology and Cell Biology, Zlotowski Center for Neuroscience, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, 8410501, Israel.
Department of Neurosurgery, Hadassah-Hebrew University Medical Center, P.O. Box 12000, Jerusalem, 91120, Israel.
Childs Nerv Syst. 2016 May;32(5):881-5. doi: 10.1007/s00381-015-2924-y. Epub 2015 Oct 5.
The relationship between tonsil position and symptomatic cerebellar contusion is unclear. To date, there are no reports of symptomatic traumatic brain injury associated with benign tonsillar ectopia. Reported cases are limited to prominent cerebellar tonsillar displacement by ≥5 mm (i.e., Chiari malformations).
The authors describe a case of symptomatic concussion in a toddler with unusual computerized tomography (CT) presentation and incidental finding of benign tonsillar ectopia, hemorrhagic contusion of the tonsils, blood-brain barrier (BBB) disruption and delayed atrophy shown using magnetic resonance imaging (MRI) studies. The radiological presentation and the clinical challenges are discussed through a review of the literature.
This case suggests that damage to cerebellar structures is not limited only to overt tonsillar herniation. Benign tonsillar ectopia may predispose to cerebellar contusion even after minor concussion and thus has a clinical significance. The current paradigm viewing only noticeable tonsillar herniation as a risk factor for hindbrain injury should be revisited.
扁桃体位置与有症状的小脑挫伤之间的关系尚不清楚。迄今为止，尚无关于与良性扁桃体异位相关的有症状创伤性脑损伤的报道。已报道的病例仅限于小脑扁桃体明显移位≥5毫米（即Chiari畸形）。
作者描述了一例幼儿有症状性脑震荡的病例，其计算机断层扫描（CT）表现异常，并偶然发现良性扁桃体异位、扁桃体出血性挫伤、血脑屏障（BBB）破坏以及磁共振成像（MRI）研究显示的延迟性萎缩。通过文献回顾讨论了放射学表现和临床挑战。
该病例表明，小脑结构的损伤不仅限于明显的扁桃体疝。即使在轻度脑震荡后，良性扁桃体异位也可能易导致小脑挫伤，因此具有临床意义。应重新审视目前仅将明显的扁桃体疝视为后脑损伤危险因素的范式。
