Li Shuo, Garg Gunjan, Goyal Bobby, Abdelbaki Ahmed, Hegde Rahul, Kumar Anil, Rosovsky Mark
Department of Interventional Radiology, University of Miami/Jackson Memorial HospitalMiamiFlorida.
Department of Radiology, Yale New Haven Health Bridgeport HospitalBridgeportConnecticut.
Proc (Bayl Univ Med Cent). 2019 Jan 24;32(1):82-84. doi: 10.1080/08998280.2018.1536586. eCollection 2019 Jan.
Rhombencephalitis is a rare and potentially fatal condition involving the brainstem, with infectious, autoimmune, and paraneoplastic etiologies. We present a patient presenting with left-extremity weakness and dysphonia who had brainstem imaging findings suggestive of rhombencephalitis. We suspect that the case was due to inoculation of the brainstem from nasopharyngeal adenoviral infection. Due to heavy cocaine use, extensive basiocciput erosion led to direct contact between the brainstem and the nasopharyngeal mucosa. The patient's milder clinical course might have been due to some degree of pre-existing immunity against adenovirus. Additionally, clinicians need to be aware of the proximity of the brainstem to the nasopharynx when there is basiocciput erosion, due to the potential risk of injury during instrumentation.
菱脑炎是一种罕见且可能致命的累及脑干的疾病，病因包括感染性、自身免疫性和副肿瘤性。我们报告一名出现左侧肢体无力和发音困难的患者，其脑干影像学表现提示菱脑炎。我们怀疑该病例是由于鼻咽部腺病毒感染侵袭脑干所致。由于大量使用可卡因，枕骨基部广泛侵蚀导致脑干与鼻咽黏膜直接接触。患者较轻的临床病程可能归因于一定程度的腺病毒既往免疫力。此外，当存在枕骨基部侵蚀时，临床医生需要意识到脑干与鼻咽部的邻近关系，因为在器械操作过程中存在潜在的损伤风险。
