Quadruple under pressure

Introduction Quadrilateral compression syndrome (also known as Parinaud syndrome) refers to an intracranial mass or pineal gland that compresses the oculomotor nucleus of the midbrain dorsal sac, which in turn causes ocular dyskinesia, which is manifested as a vertical movement barrier of the eyeball. That is, the two eyeballs are the same as the upward and lower vision movement obstacles, accompanied by the pupil dilated or unequal. Occurs in children, 1/3 of patients have sexual precocity; tumor compression symptoms may have headache and vomiting; invasion of hypothalamic diabetes insipidus or other hypothalamic neuropsychiatric symptoms of the nervous system, the symptoms are mainly two eyes can not see, eye movement Nerve paralysis, eye movement disorders, ataxia, pupillary reflex changes, including A-Robo pupil drowsiness.

Cause

The chorionic tissue and germ cell tumor of the teratoma of the pineal gland can secrete hormones secreted by HCG, which is sufficient to cause precocious puberty. Such tumors have the histological and functional characteristics of choriocarcinoma.

Pineal tumors lead to precocious puberty, which may affect the regulation of the hypothalamus or the secretion of HCG due to tumor compression or destruction. Neuroendocrine anatomical results suggest that premature puberty is caused by the expansion of other tumors in the brain that extend to the pineal gland.

Another possible cause of precocious puberty is that the pineal gland produces a substance that inhibits the secretion of gonadotropin from the pituitary gland. For example, the pineal gland is destroyed by inhibition and produces precocious puberty. It is also possible that the tumor transcends the pineal region and causes the first The third ventricle accumulates water or damages the hypothalamus to cause precocious puberty.

an examination

Related inspection

Tumor gene P53 antibody (P53-AB) tumor associated antigen

1. History of symptoms:

Occasionally occurs in 1/3 of children with precocious puberty; tumor compression symptoms may have headache and vomiting; invasion of hypothalamic diabetes insipidus or other hypothalamic neuropsychiatric nervous system, the symptoms are mainly in the two eyes can not see, oculomotor nerve Paralysis, eye movement disorders, ataxia, pupillary reflex changes, including A-Robo pupil drowsiness.

Tumor compression quadruple appears pupil dilated, and the two eyeballs are the same as the up-and-down dyskinesia called quadrilateral syndrome. Can also cause cerebellar ataxia, endocrine symptoms have the characteristics of sexual precocity, and sometimes due to tumor involvement in the third ventricle caused by autonomic disorders such as cyanosis.

2. Physical examination found:

There may be decreased vision, abnormal gait of the optic nerve head edema.

Differential diagnosis

Ventricular pressure displacement: refers to CT examination or cerebral angiography to find ventricular displacement, ventricular compression, and more often in brain trauma or brain tumors.

Spinal thalamic bundle compression: When the spinal cord is compressed, the dyskinesia occurs before the sensory disturbance. In addition to the compression of the spinal cord tissue, it may be accompanied by blood circulation disorders, cerebrospinal fluid dynamics, and complications such as inflammation and adhesion. Therefore, clinical performance presents diversity and complexity.

Spinal cord compression: fracture displacement, broken bone fragments and broken discs can be directly compressed into the spinal canal, and the pleated yellow ligament and rapidly forming hematoma can also compress the spinal cord, causing a series of pathological changes of spinal cord injury. .

Spinal nerve compression: The spinal nerve is a mixed nerve whose sensory fibers begin in pseudomonopolar neurons of the spinal ganglia. The central protrusion of the pseudo-monopolar neurons is rooted into the spinal cord; the peripheral protrusions are added to the spinal nerves, distributed in the skin, muscles, joints, and visceral receptors, etc., and the sensory impulses of the body and the internal organs are transmitted to the center. The motor fibers are composed of the anterior horn of the gray matter, the thoracolumbar lateral angle, and the axons of the parasympathetic nucleus motor neurons distributed in the striated muscle, smooth muscle, and gland. Compression of the spinal nerves can lead to numbness in the limbs and limited sensory and motor function.

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