外伤性气颅致神经及精神障碍病例分析

Post-traumatic intracranial pneumatosis induced neurological and mental disorders: A case report

目的:对外伤后颅内积气80d积气不吸收且增多,致精神障碍和智力、记忆力空间结构障碍的病例进行分析。方法:结合临床表现进行了①神经眼科APS-5000自动视野仪定量检测;②鼻腔无色透明液体糖定量;③99Tcm标记的亚锡喷替酸ECT漏口显像;④头颅CT;⑤脑电图和脑电地形图;⑥艾森克人格问卷;⑦明尼苏达多相人格调查表;⑧症状自评量表;⑨中国修订韦氏成人智力量表;⑩临床记忆量表的检查。结果:①自动视野仪定量检测未发现明确视野缺损;②ECT脑脊液显像考虑右侧大脑额叶近额窦部为漏口;鼻腔液体糖定量证实是脑脊液;③头颅CT额叶及侧脑室双侧裂,环池见低密度气体影,额骨骨皮质不连续,骨质下陷;④脑电图右额、颞不规则慢波,有θ波发作;脑电地形图:右额δ功率值增高;⑤艾森克人格问卷:内外向分55、神经质分55,精神质分80,掩饰分50;⑥明尼苏达多相人格调查表:编码显示69/96模式,提示脑器质性偏执型精神分裂症;⑦症状自评量表:总分147、阳性项目分37,躯体化、强迫状态、人际关系敏感、焦虑、敌对和其他6项目平均分超过常模。⑧中国修订韦氏成人智力量表:言语实际智商、全量表实际智商均较预计智商低,差异有显著性;而操作实际智商较预计智商低,差异无显著性。空间知觉、分析综合能力较短时记忆和注意力要弱;⑨临床记忆量表:提示轻度记忆障碍。根据年龄量表的结果,提示患者指向记忆、联想学习和图像自由回忆损伤尤其严重,无意义图形再认和人像特点回忆也在同年龄组中等水平以下。结论:外伤致颅内积气伴脑脊液鼻漏治疗不及时会造成慢性外伤后张力性气颅,对称或非对称空气积聚,占据颅腔空间,产生占位效应,压迫并刺激脑组织。外伤性气颅可以导致精神障碍和智力、记忆力和空间结构等高级神经功能障碍。

AIM： To analyze one case with mental disorders and intellectual, memory and spatial obstacles caused by post-traumatic intracranial pneumatosis for 80 days and the pneumatosis was increased instead of being absorbed. METHODS： In combination with the clinical manifestations, the followings were performed： ① quantitative detection with APS-5000 automatic sight apparatus in the Department of Neurological Ophthalmology; ② achromatic color clear liquid glucose quantitation in nasal cavity; ③tetrofosmin ^99Tc^m labeled pentetate acid and stannous chloride ECT leakage imaging; ④ cranial CT;⑤ electreencepalogram （ECG） and brain topographic mapping; ⑥ Eysenck personality questionnaire （EPQ）; ⑦ Minnseota multiphasic personality inventory （MMPI）; ⑧ Symptom checklist （SCL）;⑨ Wechsler adult intelligence scale-Chinese revised （WAIS-CR）; （10）clinical memory scale （CMS）. RESULTS： ①No obvious sight defect was detected with the quantitative deteetion of automatic sight apparatus. ② ECT cerebrospinal fluid imaging thought that proximal frontal sinus of right cerebral frontal lobe was the leakage, and the liquid glucose in nasal cavity was quantitatively confirmed to be cerebrospinal fluid. ③ Cranial CT showed that cleft could be observed in bilateral frontal lobe and lateral ventricle, lowdensity gas shadow could be observed in cisterna ambiens, cortex of frontal bone was discontinuous, and bone matrix was trapped. ④ ECG showed that right forehead and temple had irregular slow wave, and attack of 0 wave. Brain topographic mapping showed that the 8 power value of right forehead was increased. ⑤ EPQ： The scores Of extraversion-introversion, neuroticism, psychoticism and lie were 55, 55, 80 and 50 respectively; ⑥MMPI： The code showed a mode ＇of 69/96, indicating that the brain organ tended to paranoid schizophrenia. ⑦ SCL： The total score was 147, the score of positive items was 37, and the average scores of somatization, interpersonal sensitivity, anxiety, hostility and others were higher than those in norms. ⑧WAIS-CR： The actual intelligence quotients of language and total scale were significantly lower than predicted ones, but that of operation was insignificantly lower than the predicted one, The spatial awareness and abilities of analysis and comprehension were weaker than short-term memory and attention. ⑨ CMS： It was indicated that there was mild memory disorders. According to the results of age scale, it was suggested that the damages of directive memory, association learning and image free memory were more severe, and the recognition to meaningless picture and memory of portrait characters were also lower than those in the same age group and the middle level. CONCLUSION： If the trauma induced intracranial pneumatosis accompanied by cerebrospinal rhinorrhea is not treated in time, it will result in chronic post-traumatic tension intracranial pneumatosis, symmetrical or asymmetrical air aggregation, which will occupy the space of cranial cavity and produce a space-occupying effect, it can compress and stimulate the brain tissue. Traumatic intracranial pneumatosis can lead to mental disorders and disorders of senior neurological function, such as intellect, memory and spatial structure, etc,