Micturitional disturbance in herpetic brainstem encephalitis; contribution of the pontine micturition centre
Micturitional disturbance in herpetic brainstem encephalitis; contribution of the pontine micturition centre
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DOI：
10.1136/jnnp.64.2.269
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发表时间：
1998-02-01
影响因子：
11
通讯作者：
Yasuda, K
中科院分区：
文献类型：
--
作者：
Sakakibara, R;Hattori, T;Yasuda, K
人类疱疹脑干脑炎很少提到排尿障碍，尽管被称为脑桥排尿中心的桥脑被盖似乎调节着实验动物的下尿路。报告1例45岁男性患者，出现亚急性昏迷和打嗝样呼吸失常，需要辅助呼吸。脑脊液检查显示单核细胞增多和抗单纯疱疹病毒1型抗体，但开放压力为90cmH2O。头颅CT显示脑肿胀，主要位于后颅窝，双侧硬膜下积液。他被诊断为疱疹脑干脑炎，每天接受900毫克的阿达拉滨治疗。苏醒后，他出现左侧滑车神经麻痹、左侧眼球麻痹、失语和尿潴留。头颅MRI一侧占优势，双侧节段性病变轻微延伸至中脑和延髓。两周后，他能够排尿，但出现夜间尿频、尿失禁和排尿困难。尿动力学检查显示残余尿量为350毫升，排尿时出现逼尿肌反射减退。排尿障碍随神经体征逐渐消失。此例患者的双侧脑桥被盖损害与先前脑干中风的发现相似，这是人类脑桥排尿中心存在的证据。
Micturitional disturbance is rarely mentioned in human herpetic brainstem encephalitis although the pontine tegmentum, called the pontine micturition centre, seems to regulate the lower urinary tract in experimental animals. The case of a 45 year old man, who developed subacute coma and hiccup-like dysrhythmic breathing, and needed assisted ventilation is reported. Examination of CSF showed mononuclear pleocytosis and antibody against herpes simplex virus type 1, but the opening pressure was 90 cm H2O. Brain CT showed brain swelling, predominantly in the posterior fossa, and bilateral subdural effusion. Herpetic brainstem encephalitis was diagnosed, and he received 900 mg/day vidarabine. On regaining consciousness, he had left trochlear nerve palsy, left corectopia, ageusia, and urinary retention. Brain MRI side dominant, bilateral segmental lesions extending slightly to the midbrain and medulla. After two weeks he was able to urinate but showed nocturnal urinary frequency, urinary incontinence, and voiding difficulty. Urodynamic studies showed a residual urine volume of 350 ml and detrusor hyporeflexia on voiding. Micturitional disturbance gradually disappeared together with the neurological signs. The bilateral pontine tegmental lesions in this patient are similar to those in previous findings on brainstem strokes, evidence of the presence of a pontine micturition centre in humans.