以急性多发性脑梗死为首发表现的隐匿性躯体恶性肿瘤12例报告

发布时间：2018-05-31 01:44

本文选题：脑梗死 + 栓塞　；参考：《中国神经精神疾病杂志》2016年07期

【摘要】：目的研究以急性多发脑梗死为首发表现的隐匿性躯体恶性肿瘤患者的临床表现、实验室检查、影像学、微栓子监测检查特点,探讨其可能的发病机制。方法纳入以急性多发性脑梗死为首发表现的隐匿性躯体恶性肿瘤患者12例,收集其临床资料,分析其实验室血液学、头颅MRI、微栓子监测结果及其治疗和预后。结果所有患者均以局灶性神经功能缺损为主要表现,包括偏瘫、失语、偏身感觉障碍、构音障碍、眩晕、肢体抽搐等。头颅DWI示急性多发脑梗死,病灶播散性分布,不符合单支动脉供血区,同时累及双侧前循环或前后循环。11例行D-dimer检查者8例升高。7例行微栓子监测有5例阳性。隐匿性躯体恶性肿瘤包括:肺癌5例,胰腺癌3例,胃癌、结肠癌、子宫内膜癌、转移性低分化粘液腺癌原发肿瘤部位不明各1例;诊断时就已有远处转移者10例。病程中缺血性卒中复发者7例,急性心肌梗死4例,住院期间死亡3例,预后差。结论对于不符合单支动脉供血区的多发急性脑梗死,需要考虑可能合并隐匿性躯体恶性肿瘤,凝血功能筛查高凝状态和微栓子阳性可能是诊断提示线索。
[Abstract]:Objective to study the clinical manifestation, laboratory examination, imaging and microemboli monitoring of occult somatic malignant tumors with acute multiple cerebral infarction, and to explore its possible pathogenesis. Methods Twelve patients with occult somatic malignant tumors with acute multiple cerebral infarction were included. The clinical data were collected and the results of laboratory hematology, cranial MRI, microemboli monitoring, treatment and prognosis were analyzed. Results all the patients presented with focal neurological impairment, including hemiplegia, aphasia, hemiplegia, dysarthria, vertigo, limb convulsion and so on. Cranial DWI showed acute multiple cerebral infarction with diffuse distribution, which was not in accordance with the blood supply area of single branch artery. In 8 cases with D-dimer examination, 7 cases were positive for microemboli monitoring. 11 cases involved bilateral anterior circulation or anterior and posterior circulation. 7. 7 cases were examined with microemboli. Occult somatic malignant tumors included 5 cases of lung cancer, 3 cases of pancreatic cancer, 1 case of gastric cancer, 1 case of colon cancer, 1 case of endometrial carcinoma, 1 case of metastatic poorly differentiated mucinous adenocarcinoma, and 10 cases of distant metastasis at the time of diagnosis. There were 7 cases of recurrent ischemic stroke, 4 cases of acute myocardial infarction and 3 cases of death during hospitalization. The prognosis was poor. Conclusion for multiple acute cerebral infarction which does not accord with the single branch blood supply area, it is necessary to consider the possibility of complicated with occult somatic malignant tumor. The screening of hypercoagulable state and microemboli positive may be the diagnostic cues.
【作者单位】：北京大学第一医院神经内科;中日友好医院干部医疗科;中日友好医院神经内科;
【分类号】：R743.3;R73

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