Yano K, Kuroda T, Tanabe Y, Yamada H
Department of Neurosurgery, Gifu Municipal Hospital.
Neurol Med Chir (Tokyo). 1994 Sep;34(9):593-6. doi: 10.2176/nmc.34.593.
Three cases of peduncular hallucinosis occurred in patients with aneurysmal subarachnoid hemorrhage. All patients underwent early clipping of the ruptured aneurysms of the anterior circulation. Several days after onset of subarachnoid hemorrhage, the patients complained of vivid visual hallucinations associated with abnormal sleep-waking rhythms, suggesting a diagnosis of peduncular hallucinosis. The hallucinations disappeared with administration of an increased dose of dobutamine. These findings indicated that peduncular hallucinosis might be a manifestation of delayed cerebral ischemia after subarachnoid hemorrhage. No other possible cause of neurological deficits such as hydrocephalus, cerebral infarcts, or metabolic encephalopathies was identified. Damage to the ascending reticular activating system has been implicated in the pathogenesis of peduncular hallucinosis. Cerebral vasospasm in the perforating arteries of the ascending reticular activating system was probably the cause of the hallucinosis in our patients.
三例大脑脚幻觉症发生于动脉瘤性蛛网膜下腔出血患者。所有患者均接受了前循环破裂动脉瘤的早期夹闭术。蛛网膜下腔出血发病几天后，患者主诉出现生动的视幻觉，并伴有异常的睡眠-觉醒节律，提示大脑脚幻觉症的诊断。给予加大剂量的多巴酚丁胺后幻觉消失。这些发现表明，大脑脚幻觉症可能是蛛网膜下腔出血后迟发性脑缺血的一种表现。未发现其他可能导致神经功能缺损的原因，如脑积水、脑梗死或代谢性脑病。上行网状激活系统受损与大脑脚幻觉症的发病机制有关。上行网状激活系统穿通动脉的脑血管痉挛可能是我们患者发生幻觉的原因。
