Schlitt M, Duvall E R, Bonnin J, Morawetz R B
Surg Neurol. 1986 Jul;26(1):67-71. doi: 10.1016/0090-3019(86)90066-2.
Ten years after a diagnosis of sarcoidosis, a 33-year-old woman presented with a severe headache of 5 days' duration. Neuroradiologic evaluation revealed a large cystic lesion of the left temporal lobe, causing a mass effect. An exploratory operation proved the lesion to be a loculated portion of the temporal horn of the lateral ventricle. Drainage of the loculated ventricle relieved the patient's cephalgia. Within 2 months, however, pain in the head recurred and an unsteady, broad-based gait appeared. Reevaluation disclosed hydrocephalus for which a ventriculoperitoneal shunt was inserted. After this procedure, the patient did well neurologically for 1 year, after which seizures, personality changes, incontinence, and disturbance of gait developed. Death occurred after revision of the shunt, and widespread granulomatous disease was found at autopsy. Neurosarcoidosis, with emphasis on intracranial mass lesions in sarcoidosis, is discussed; the role of surgical treatment in some of these lesions, and in hydrocephalus, is stressed.
结节病诊断十年后，一名33岁女性出现持续5天的严重头痛。神经放射学评估显示左颞叶有一个大的囊性病变，产生占位效应。一次探查性手术证实该病变是侧脑室颞角的一个分隔部分。分隔脑室引流缓解了患者的头痛。然而，在2个月内，头痛复发，出现了步态不稳、基底增宽的症状。再次评估发现脑积水，遂插入脑室腹腔分流管。此手术后，患者神经功能良好达1年，之后出现癫痫、人格改变、失禁和步态障碍。在分流管翻修后患者死亡，尸检发现广泛的肉芽肿性疾病。本文讨论了神经结节病，重点是结节病中的颅内占位性病变；强调了手术治疗在其中一些病变以及脑积水治疗中的作用。
