摘要
目的分析脑膜癌病(MC)合并脑静脉窦血栓形成(CVST)的临床特点。方法回顾性分析我院收治的4例患者的临床及影像、病理资料。结果4例患者中男1例,女3例,年龄48～64岁。主要症状为头痛和颅压高的表现。其中2例有消化道肿瘤手术病史,1例有肝硬化史,另外1例缺乏明确的肿瘤病史。4例患者的腰穿压力均>320mmH2O,脑脊液中糖含量与血糖的比值下降,平均为0.38。MC中2例由脑脊液病理确诊,1例通过尸检证实,另1例虽然缺乏病理支持,但包括正电子发射体层扫描(PET)在内的影像学检查、肿瘤标志物等检查均明显异常而确诊。CVST的诊断3例由数字减影血管造影(DSA)检查确诊,1例由磁共振静脉血流成像(MRV)确诊。4例中MRI显示3例侧脑室变大,1例合并静脉性脑梗死。结论中老年患者颅压高的症状早期轻,后期发展迅速,影像检查缺乏脑实质病变,脑室扩大的CVST以及严重程度与临床表现不一致的CVST往往提示有MC合并CVST的可能。
Objective To analyze the clinical characteristics of meningeal carcinomatosis （MC） complicating with cerebral venous sinus thrombosis （CVST）, Methods The clinical features, image and pathological manifestations of 4 patients admitted to our hospital during 1990-2005 were retrospectively analyzed. Results One was male and 3 were female and their age ranged from 48 to 64 years old. The main complaint was headache and the symptoms of high intracranial pressure, 2 of them had the history of digestive tract tumor operation, 1 had hepatic cirrhosis, and 1 was failed to find any tumor. The intracranial pressures were significantly increased in all cases, and the ratios of sugar in cerebrospinal fluid （CSF） and that in blood were decreased. 2 MC cases were diagnosed by pathology in CSF, 1 was by autopsy and the last one had marked abnormality in image examination including PET and tumor marker, thought it was not supported by pathology in CSF. In the MRI examination, 3 of them had enlargement of lateral ventricle, and 1 was complicated with cerebral venous infarction, The diagnosis of CVST was performed by DSA examination in 3 cases, and MRV was used in the other one. Conclusions The symptom of high intracranial pressure is mild in old patient but develops quickly in the late stage, It maybe indicate MC complicating with CVST if the patient has CVST with enlargement of lateral ventricle but without cerebral changes in image examination, or the clinical manifestation is not consistent with the severity of CVST.
出处
《北京医学》
CAS
2007年第3期135-138,共4页
Beijing Medical Journal
关键词
脑膜癌病
脑静脉窦血栓形成
临床
病理
Meningeal carcinomatosis（MC） Cerebral venous sinus thrombosis（CVST） Clinic Pathology
