以急性脑梗死为首发表现的隐匿性恶性肿瘤的临床分析

发布时间：2018-02-02 07:16

本文关键词： 肿瘤恶性脑梗死复发　出处：《中国脑血管病杂志》2017年12期 　论文类型：期刊论文

【摘要】：目的通过对急性脑梗死为首发表现的隐匿性恶性肿瘤患者的临床表现、实验室检查及影像学特点进行分析,以加强对急性脑梗死患者的肿瘤筛查。方法收集自2013年1月至2015年1月北京大学第三医院神经内科收治的1 139例急性脑梗死患者,其中8例(0.7%)患者在住院期间发现躯体恶性肿瘤。回顾8例患者的临床表现、危险因素、影像学改变、D-二聚体水平等化验结果及预后,并复习相关文献进行讨论。结果 8例以脑梗死为首发表现的恶性肿瘤患者,年龄为58~78岁,平均(70±3)岁,男6例,女2例;其中5例为肺癌,肝内胆管细胞癌、结肠癌以及前列腺癌各1例;3例多次发生脑梗死患者于住院期间因呼吸衰竭死亡,其确诊卒中至死亡间隔时间分别为49、95及28 d。5例患者完善了D-二聚体检查,其中2例D-二聚体水平(分别为0.73μg/L及3.0μg/L)升高;8例完善肌酸激酶同工酶(CK-MB)检测的患者中,2例CK-MB水平(分别为31 U/L及49 U/L)升高,其中1例确诊为急性心肌梗死。所有患者完善头部MRI扩散加权成像和脑血管检查,仅1例患者脑梗死病灶与狭窄血管一致;6例患者为双侧大脑半球且前后循环同时发生多发性脑梗死,且MRI扩散加权成像提示脑梗死病灶均为多支血管供血的小点片状或大面积脑梗死。结论对病因不明的多发性脑梗死患者,尤其是早期卒中反复的患者,需要注意躯体恶性肿瘤的可能性,且急性脑梗死早期复发提示预后不佳。
[Abstract]:Objective to analyze the clinical, laboratory and imaging features of occult malignant tumors with acute cerebral infarction. Methods from January 2013 to January 2015, 1 139 patients with acute cerebral infarction were treated in Department of Neurology, third Hospital of Peking University. The clinical manifestations, risk factors, imaging changes of D-dimer and prognosis of 8 patients were reviewed. Results the age of 8 patients with malignant tumor with cerebral infarction as the first manifestation was 58 ~ 78 years old with an average age of 70 卤3 years, 6 males and 2 females. There were 5 cases of lung cancer, 1 case of intrahepatic cholangiocarcinoma, 1 case of colon cancer and 1 case of prostate cancer. Three patients with multiple cerebral infarction died of respiratory failure during hospitalization. The interval between the diagnosis of stroke and death was 490.95 and 28d, respectively. The D-dimer examination was improved in 3 patients. In 2 cases, the level of D-dimer (0.73 渭 g / L and 3.0 渭 g / L) was increased. In 8 patients with perfect creatine kinase isoenzyme detection, CK-MB levels were increased in 2 patients (31 Ur / L and 49 UL, respectively). One case was diagnosed as acute myocardial infarction. All the patients had complete head MRI diffusion weighted imaging and cerebrovascular examination, only one patient had cerebral infarction focus consistent with stenosis vessel. Multiple cerebral infarction occurred simultaneously in 6 patients with bilateral cerebral hemispheres. MRI diffusion-weighted imaging showed that cerebral infarction lesions were small or large area cerebral infarction with multi-vessel blood supply. Conclusion for patients with multiple cerebral infarction with unknown etiology, especially in patients with recurrent early stroke. Attention should be paid to the possibility of somatic malignant tumors, and early recurrence of acute cerebral infarction suggests poor prognosis.
【作者单位】：北京大学第三医院神经内科;
【分类号】：R730.5;R743.33
【正文快照】： 作者单位:100191北京大学第三医院神经内科Corresponding author:Fan Dongsheng,Email:dsfan2010@aliyun.com恶性肿瘤与急性脑梗死均是老年人的常见死亡原因,且恶性肿瘤患者发生脑血管事件的发病率较普通人群高,尸检发现约14.6%恶性肿瘤患者曾发生急性脑梗死[1]。多种机制参与

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