脑卒中样起病脑胶质瘤(附1例报告及文献复习)  

Stroke-like Onset Glioblastoma(One Case Report and Literature Review)

作　　者：王玥明 孙沁怡[2] 胡斌 程忻 WANG Yue-ming;SUN Qin-yi;HU Bin;CHENG Xin(Department of Neurology,National Clinical Research Centre for Aging and Medicine,Huashan Hospital,State Key Laboratory of Medical Neurobiology,Fudan University,Shanghai 200040,China;Department of Neurology,the Affiliated Suzhou Hospital of Nanjing Medical University,Suzhou Jiangsu 215001,China;Department of Radiology,Huashan Hospital,Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属华山医院神经内科,国家老年疾病临床研究中心,上海200040 [2]南京医科大学附属苏州医院神经内科,苏州215001 [3]复旦大学附属华山医院影像科,上海200040

出　　处：《中国临床神经科学》2020年第5期532-537,共6页Chinese Journal of Clinical Neurosciences

基　　金：国家重点研发计划重大慢性非传染性疾病防控研究(编号:2017YFC1308201);国家重点研发计划重大慢性非传染性疾病防控研究(编号:2016YFC1300503);国家自然科学基金面上项目(编号:81971123);上海市“脑与类脑智能”市级重大科技专项资助项目(编号:No.2018SHZDZX03)和张江实验室;复旦大学老年医学专项支持计划项目。

摘　　要：目的提高对脑卒中样起病脑胶质瘤的认识。方法收集1例脑卒中样起病的胶质母细胞瘤患者的临床资料,总结发病症状、诊疗经过和影像学特点,结合文献复习予以分析讨论。结果患者男性,61岁。因"左侧肢体无力6 d"就诊。入院后MRI检查示右侧额顶叶、侧脑室旁多发T2高信号灶;增强示环形强化灶。20 d后复查MRI增强示病灶明显扩大。PET-CT示病灶内放射性摄取增高。脑脊液压力及蛋白轻度升高。患者于全身麻醉下行右侧额叶肿瘤切除术。术后病理诊断:右额叶胶质母细胞瘤(WHOⅣ级)。结论急性起病偏瘫患者如经治疗病情仍进行性发展,即便无明显颅高压症状,也应警惕恶性肿瘤可能,应进一步行相关影像学检查明确诊断避免误诊。Aim To improve the understanding of stroke-like onset glioblastoma. Methods One case of stroke-like onset glioblastoma was reported, its symptoms, treatment history, and imaging features were summarized with the literature review. Results A 61-year-old male with left limb weakness for 6 days was admitted in the hospital as a stroke patient. Brain magnetic resonance imaging(MRI) showed large hyperintense area in the right parietal frontal lobe, and post-contrast MRI showed a ring-enhancing lesion, with a fast progression of the lesion size after 20 days. Lumbar puncture examination showed a mild elevation of cerebrospinal fluid pressure and protein, and PET-CT revealed increased uptake within the foci. The patient underwent right frontal lobe tumor resection, and the surgery proved a right frontal lobe WHO grade glioblastoma. Conclusion Patients with acute onset hemiplegia whose symptoms got worse after the treatment should be alerted to the possibility of malignant tumor, even if there are no obvious symptoms of cranial hypertension. Further imaging examination should be carried out to confirm the diagnosis and avoid misdiagnosis.

关 键 词：脑卒中 脑胶质瘤 脱髓鞘性假瘤 

分 类 号：R730.264[医药卫生—肿瘤] R743[医药卫生—临床医学]