Neurology, Christian Medical College Vellore, Vellore, Tamil Nadu, India.
Radiology, Christian Medical College Vellore, Vellore, Tamil Nadu, India.
BMJ Case Rep. 2021 Feb 1;14(2):e238893. doi: 10.1136/bcr-2020-238893.
This report describes two patients with acute-onset ptosis, oculomotor dysfunction, ataxia and drowsiness, referable to the midbrain tegmentum. Both patients had previously suffered severe closed head injuries requiring craniotomy for cerebral decompression. Serial brain scans in both cases revealed a newly developing cleft in the midbrain, with features suggestive of abnormal cerebrospinal fluid (CSF) flow across the aqueduct. A trial of acetazolamide was initiated to reduce CSF production, followed by a third ventriculostomy for CSF diversion in one patient, which resulted in arrested disease progression and partial recovery. There are only two previous reports in the literature of midbrain clefts that developed as remote sequelae of head trauma. We postulate that altered CSF flow dynamics in the aqueduct, possibly related to changes in brain compliance, may be contributory. Early recognition and treatment may prevent irreversible structural injury and possible death.
本报告描述了两例以急性动眼神经麻痹、眼肌运动障碍、共济失调和嗜睡为特征的中脑被盖部疾病患者。两名患者均有严重的闭合性颅脑损伤病史，需行开颅手术以进行脑减压。在这两例患者中，连续的脑部扫描均显示中脑新出现裂隙，特征提示存在异常脑脊液（CSF）经导水管流动。我们尝试使用乙酰唑胺来减少 CSF 的产生，随后对其中一名患者进行了第三次脑室造口术以进行 CSF 引流，结果疾病进展得到了控制，部分症状也得到了缓解。文献中仅有两例先前报道的中脑裂隙是头部创伤的远期后遗症。我们推测，导水管内 CSF 流动动力学的改变，可能与脑顺应性的变化有关，可能是其致病因素之一。早期识别和治疗可能防止不可逆的结构损伤和可能的死亡。
