摘要
目的分析11例脑膜癌病的临床特征及误诊原因。方法对2002年7月-2003年12月收治的11例经脑脊液细胞学证实的脑膜癌病患者的临床资料进行分析。结果首发症状多以头痛、呕吐为主,亦可有视觉障碍、复视、眼睑闭合无力、口角歪斜以及发作性上背部疼痛,可伴脑神经和脊神经损害及脑膜刺激征;头部CT及MRI均无异常发现。脑脊液检查颅内压均不同程度增高(200～400mmH2O),其中8例细胞数、蛋白升高,糖、氯化物下降;细胞学检查均发现癌细胞,形态与原发肿瘤相似,来源于肺癌者5例、乳腺癌3例、胃癌1例、卵巢癌1例、血液系统恶性淋巴瘤1例。其中5例于发现原发肿瘤之前即有神经系统症状。11例患者中6例病情恶化自动出院,2例院内死亡,3例经对症治疗症状缓解出院。结论对以头痛、呕吐发病伴脑神经、脊神经受损,并出现脑膜刺激征和颅内压增高,头部CT及MRI无明显异常者,应考虑脑膜癌病的可能,及早行全身检查寻找原发病灶,以脑脊液发现癌细胞为确诊依据。
Objective To analyze the clinical characteristics and the causes of misdiagnosis in 11 patients with meningeal carcinomatosis. Methods The clinical data of 11 patients with meningeal carcinomatosis admitted during July 2002 to December 2003 and definitely diagnosed by CSF cytological detection were retrospectively analyzed. Results Most of the onset symptoms of these meningeal carcinomatosis were headache, vomiting also including visual disturbances, diplopia, weakness in closing eyelids, deviation of mouth angle and paroxysmal upper back pain; cranial and spinal nerve injury and signs of meningeal irritation might be associated. There were abnormal levels of intracranial pressure in different extent (200-400 mmH2O); increased cell count and protein level and decreased chloride and glucose levels were found in CSF examination. Cancer cells were found and their morphological appearences were similar with that in primary tumor. These meningeal carcinomatosis were originated from lung cancer (n=5), breast cancer (n=3), stomach cancer (n=1), ovary cancer (n=1) and hematological malignant lymphoma (n=1). The neurological symptoms occurred in 5 patients before finding of primary cancer. Of the 11 patients there were 6 cases discharged due to exacerbation, 2 dead in hospital and 3 patients discharged after symptomatic remission by expectant treatment. Conclusion The meningeal carcinomatosis should be highly suspected in patients with headache, vomiting, cranial and spinal nerve lesion, signs of meningeal irritation, increased ICP, even presenting normal CT and MR imaging. Overall examination should be conducted to find the underlying tumor. Occurrence of cancer cell in CSF is the evidence for definite diagnosis.
出处
《中国现代神经疾病杂志》
CAS
2004年第5期301-304,共4页
Chinese Journal of Contemporary Neurology and Neurosurgery
