Epilepsy case with focal cerebral herniation into the sigmoid sinus.
Epilepsy case with focal cerebral herniation into the sigmoid sinus.
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癫痫病例，伴有乙状窦局灶性脑疝。
DOI：
10.1007/s10072-015-2430-8
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发表时间：
2016
期刊：
影响因子：
3.3
通讯作者：
Nakasato N
中科院分区：
文献类型：
--
作者：
Kakisaka Y;Sato S;Takayanagi M;Nakasato N
隐匿性脑膨出是一种众所周知的局部相关性癫痫的原因[1，2]，可能是由于机械牵引的刺激作用，伴有继发性炎症和神经胶质增生[2]。然而，癫痫并未与静脉窦内的隐匿性脑疝相关（4份报告中仅有8例[3-5]）。在此，我们报告一位十八岁女性癫痫合并左侧颞叶脑疝进入乙状窦及左侧脑电图异常。她在5岁时开始出现癫痫发作伴意识障碍。服用唑尼沙胺后，她的癫痫发作消失了，并在18岁时被转移到我们的过渡诊所。磁共振（MR）成像显示左颞叶部分突出，周围脑脊液进入乙状窦（图1a-d）。[18F]氟-2-脱氧-D-葡萄糖正电子发射断层扫描显示疝出的软组织中存在低代谢（图1 e）。磁共振静脉造影显示左侧乙状窦因大脑突出而向下受压（图1f）。疝的大小在13年内保持不变（图1 c，d）。最近，长期视频脑电图监测显示，在左颞区的时间间歇性节律性δ活动，这表明局部相关的癫痫病变引起的。神经放射科医师应仔细检查窦内的小病灶，以避免忽视进入硬膜静脉窦的脑疝，尤其是癫痫患者。
Occult encephalocele is a well-known cause of localization-related epilepsy [1, 2] probably due to the irritative effect of mechanical traction, with secondary inflammation and gliosis [2]. However, epilepsy has not occurred in association with occult cerebral herniation into the venous sinuses (only 8 cases in 4 reports [3–5]). Here, we present an 18-year-old female with epilepsy associated with left temporal brain herniation into the sigmoid sinus and leftsided abnormality in electroencephalography (EEG). She started to have epileptic seizures with consciousness impairment at age 5 years. She became seizure-free after medication with zonisamide and was transferred to our transition clinic at the age of 18 years. Magnetic resonance (MR) imaging demonstrated protrusion of part of the left temporal lobe and surrounding cerebrospinal fluid into the sigmoid sinus (Fig. 1 a–d).[18F] Fluoro-2-deoxy-D-glucose positron emission tomography showed hypometabolism in the herniated parenchyma (Fig. 1 e). MR venography showed downward compression of the left sigmoid sinus caused by the cerebral protrusion (Fig. 1 f). The size of the herniation remained unchanged over 13 years (Fig. 1 c, d). Recently, long-term video EEG monitoring revealed temporal intermittent rhythmic delta activity in the left temporal region, suggesting localization-related epilepsy caused by the lesion. Neuroradiologists should carefully inspect small intra-sinus lesions to avoid overlooking brain herniation into the dural venous sinuses, especially in patients with epilepsy.