磁共振表现为脑干腹侧条带状病变脑膜癌病2例临床分析  

Clinical analysis of 2 cases of meningeal carcinomatosis with ventral brainstem strip lesions demonstrated by magnetic resonance

作　　者：杨碧晖[1] 许国荣[1] 王志强[1] 林坤新 YANG Bihui;XU Guorong;WANG Zhiqiang;LIN Kunxin(Department of Neurology and Institute of Neurology of First Affiliated Hospital,Institute of Neuroscience,and Fujian Key Laboratory of Molecular Neurology,Fujian Medical University,Fuzhou 350005,China)

机构地区：[1]福建医科大学附属第一医院神经内科,福建省神经病学研究所,福建省分子神经病学重点实验室,福建医科大学,福州350005

出　　处：《中国神经精神疾病杂志》2022年第11期695-700,共6页Chinese Journal of Nervous and Mental Diseases

摘　　要：本文报告2例罕见的磁共振表现为脑干腹侧条带状异常信号病变的脑膜癌病。例1为49岁女性,因头痛、呕吐、癫痫发作入院,查体示镇静状态,右侧瞳孔直径2.5 mm,对光反应灵敏,左侧瞳孔直径1.5 mm,对光反应迟钝,双眼向右上方凝视,脑膜刺激征阳性。例2为38岁男性,因反复癫痫发作入院,查体示镇静状态,脑膜刺激征阳性。2例颅脑磁共振成像可见脑干(脑桥、延髓)腹侧表面条带状的钆增强不强化的病变,均于脑脊液中发现恶性肿瘤细胞,确诊脑膜癌病,予抗癫痫、脱水降颅压等治疗,随访2例患者均死亡。通过分析2例具有这种新型影像特征脑膜癌病的临床特征,提高临床上对该病的认识及早期诊断率。This paper reports two rare cases of meningeal carcinomatosis with MRI presentation of abnormal signal lesions in the ventral strip of the brainstem.Case 1 was a 49-year-old female admitted to the hospital with headache,vomiting,and seizures.Examination showed a sedated state with a right pupil diameter of 2.5 mm,responsive to light,and a left pupil diameter of 1.5 mm,unresponsive to light,with both eyes gazing upward to the right,and a positive meningeal irritation sign.Case 2 was a 38-year-old male admitted with recurrent seizures,and the examination showed a sedated state with a positive meningeal irritation sign.Brain MRI showed non-enhancing lesions in the ventral surface of the brainstem(pons and medulla)in these two cases.Malignant tumor cells were detected in the cerebrospinal fluid in both cases.and the diagnosis of meningeal carcinomatosis was confirmed.Patients were treated with antiepilepsy and dehydration to lower cranial pressure,and both patients died at follow-up.We analyzed the clinical features of two cases of meningeal carcinomatosis with this novel imaging feature to improve the clinical understanding and early diagnosis of this disease.

关 键 词：脑膜癌病 软脑膜转移 癌性脑膜炎 磁共振 脑干 肺腺癌 

分 类 号：R651[医药卫生—外科学]