PDF(Pubmed)
Abstract：
We describe a man aged 33 years who developed multiple symptoms, personality change, and a severe tic disorder following a road traffic accident, which were undiminished for 3 years until jugular venous narrowing between the styloid process of the skull and the transverse process of the C1 vertebra was treated by surgical decompression. Immediately following surgery, his abnormal movements almost completely resolved, with no regression in 5 years of follow-up. Vigorously debated at the time was whether or not his condition represented a functional disorder. Unrecognized throughout his illness, however, was a complaint of intermittent, profuse discharge of clear fluid from his nose that began on the day of the accident and continued up to the time of surgery, after which it was substantially reduced. This outcome reinforces the idea that jugular venous narrowing can cause or perpetuate a cerebrospinal fluid leak. It suggests that the interaction between these two pathological defects may have a profound effect on brain function in the absence of any demonstrable brain lesion. It invites a reevaluation of normal head and neck venous anatomy. It should strike a cautionary note in the diagnosis of functional illness. It invites exploration of a remediable structural cause for Tourette syndrome.
摘要：
我们描述了一个33岁的男人，他出现了多种症状，人格改变,道路交通事故后的严重抽动障碍，在手术减压治疗颅骨茎突和C1椎骨横突之间的颈静脉狭窄之前，3年未减弱。手术后立即，他的异常动作几乎完全解决了，随访5年无消退。当时激烈争论的是他的病情是否代表功能障碍。在他的整个疾病中都没有被认出来，然而,是间歇性的抱怨，从事故发生当天开始，从他的鼻子大量排出清澈的液体，一直持续到手术时，之后大幅减少。这一结果强化了颈静脉狭窄可导致或延续脑脊液漏的观点。这表明，在没有任何明显的脑损伤的情况下，这两种病理缺陷之间的相互作用可能会对大脑功能产生深远的影响。它要求重新评估正常的头颈部静脉解剖结构。它应该在功能性疾病诊断中引起注意。它邀请探索Tourette综合征的可补救结构原因。
