Miyamoto M, Miyamoto T, Hirata K, Katayama S
Department of Neurology, Dokkyo University, School of Medicine, Tochigi, Japan.
Psychiatry Clin Neurosci. 1998 Apr;52(2):212-6. doi: 10.1111/j.1440-1819.1998.tb01037.x.
A 43-year-old woman presented with dull headache, left tinnitus and dizziness. Neurological examination revealed down-beat gaze nystagmus, left tinnitus, positive Romberg sign, poor standing on the left foot, poor tandem gait, left spastic gait and positive pathological reflexes in the bilateral upper and lower extremities. Plain X-ray of the skull and cervical vertebrae demonstrated basilar impression and atlantoaxial fusion. Magnetic resonance imaging of the brain and cervical spine showed cerebellar tonsil descent and syringomyelia located in the left side of the spine at the II-III vertebral level which communicated with the fourth ventricle. The patient was diagnosed as having cervical syringomyelia. Arnold-Chiari type I malformation and basilar impression. Preoperative polysomnography showed dysrhythmic breathing and bradypnea during sleep. Abnormal breathing improved after suboccipital decompression craniotomy and upper cervical laminectomy. It was suggested that dysrhythmic breathing was caused by a disorder of the medullary respiratory center. Herniation of the cerebellar tonsil and syringomyelia might have compressed the medulla.
一名43岁女性出现钝痛性头痛、左耳耳鸣和头晕。神经系统检查发现下跳性凝视眼球震颤、左耳耳鸣、闭目难立征阳性、左脚站立不稳、串联步态不佳、左侧痉挛性步态以及双侧上下肢病理反射阳性。头颅和颈椎X线平片显示颅底凹陷和寰枢椎融合。脑部和颈椎磁共振成像显示小脑扁桃体下疝以及位于脊柱左侧第II - III椎体水平与第四脑室相通的脊髓空洞症。该患者被诊断为患有颈髓空洞症、I型阿诺德 - 基亚里畸形和颅底凹陷。术前多导睡眠图显示睡眠期间呼吸节律不齐和呼吸过缓。枕下减压开颅术和上颈椎椎板切除术后异常呼吸得到改善。提示呼吸节律不齐是由延髓呼吸中枢紊乱引起的。小脑扁桃体疝和脊髓空洞症可能压迫了延髓。
