目的 探讨伴脊髓病变脑膜癌病的临床和影像学特点,提高认识和诊疗水平.方法 回顾性分析2014年1月—2017年1月首都医科大学宣武医院神经内科收治的伴脊髓病变脑膜癌病7例患者的临床及影像学资料.结果 7例患者中男5例,女2例,年龄15~57(42.3 ± 16.6)岁.临床表现头痛3例,头晕2例,复视3例,视力下降2例,癫痫2例.7例患者均行腰穿检查,CSF白细胞均升高,蛋白升高6例,葡萄糖降低5例,IgG升高7例.7例患者均行头颅及脊髓MR检查,均可见脊髓白质异常信号,脊膜强化4例,脑膜强化3例.患者住院期间均给予对症治疗,经随访所有患者均于明确诊断后2~5个月死亡.结论 脑膜癌病除常引起脊膜、脊神经根受累之外,也可发生脊髓内病变.加强髓内病变发生机制认识有利于对脑膜癌病的理解.%Objective To investigate the clinical and imaging features of meningeal carcinomatosis accompanied by spinal cord lesion,so as to improve the level of diagnosis and treatment. Methods The clinical and imaging data of 7 pa-tients with spinal cord lesion and meningeal carcinomatosis who were treated in neurology department of Xuanwu Hospital of Capital Medical University from January 2014 to January 2017 were analyzed retrospectively. Results In the 7 patients,male of 5 cases,female of 2 cases. The average age was 15-57(42.3 ± 16.6)years.Headache occurred in 3 cases,vertigo in 2 ca-ses,diplopia in 3 cases,visual impairment in 2 cases,and epilepsy in 2 cases. All cases underwent lumbar puncture, CSF WBC were all increased,6 cases with elevated protein,5 cases with decreased sugar. 7 cases underwent MR examination of the head and spinal cord. The abnormal signals of white matter of the spinal cord were seen,4 cases were strengthened by me-ninges,and 3 cases of meningeal enhancement. All patients were given symptomatic treatment during hospitalization. All pa-tients died 2-5 months after the definitive diagnosis. Conclusion Meningeal carcinomatosis,besides the involvement of spi-nal meninges and spinal nerve roots,can also cause spinal cord lesions. Understanding the pathogenesis of intramedullary le-sions is beneficial to the understanding of meningeal carcinomatosis.
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