Inafuku T, Sakai F, Sakamoto T, Iizuka T, Kanda T
Department of Internal Medicine, School of Medicine, Kitasato University.
Rinsho Shinkeigaku. 1994 May;34(5):484-8.
We presented a 65-year-old man with the right occipital dural arteriovenous malformation (AVM) who first experienced photopsia in his left inferior quadrantanopic field and then developed formed hallucinations 8 days later. His visual hallucinations disappeared with saccadic eye movements. EEG showed no epileptic discharge. MRI revealed hyperintensity in the right medial occipital lobe on proton density image. 123I-IMP SPECT during the hallucinations revealed decrease of regional cerebral blood flow (r-CBF) not only in the right medial occipital lobe but also in the right lateral occipital and in the right medial temporal lobe. Both left inferior quadrantanopia and visual hallucinations disappeared following the treatment of the dural AVM by transarterial embolizations. Because the lesion on MRI improved after the treatment, we considered that the lesion was brain edema, not infarction. Additionally decreased r-CBF in the temporo-occipital lesion on SPECT improved after the treatment, we emphasized the role of the temporo-occipital lesion as the cause of visual hallucinations in the hemianopic field.
我们报告了一名65岁男性,患有右侧枕部硬脑膜动静脉畸形(AVM),他首先在左下象限盲视野中出现光幻视,8天后出现成形幻觉。他的视幻觉随着眼球跳动而消失。脑电图显示无癫痫放电。磁共振成像(MRI)在质子密度图像上显示右侧枕叶内侧高信号。幻觉发作期间的123I-异碘安非他明单光子发射计算机断层扫描(SPECT)显示,局部脑血流量(r-CBF)不仅在右侧枕叶内侧减少,在右侧枕叶外侧和右侧颞叶内侧也减少。经动脉栓塞治疗硬脑膜AVM后,左下象限盲和视幻觉均消失。由于治疗后MRI上的病变有所改善,我们认为该病变是脑水肿,而非梗死。此外,SPECT上颞枕部病变处减少的r-CBF在治疗后有所改善,我们强调颞枕部病变作为偏盲视野中视幻觉病因的作用。