發(fā)布時(shí)間：2018-05-31 01:44

  本文選題：腦梗死 + 栓塞　； 參考：《中國(guó)神經(jīng)精神疾病雜志》2016年07期

【摘要】：目的研究以急性多發(fā)腦梗死為首發(fā)表現(xiàn)的隱匿性軀體惡性腫瘤患者的臨床表現(xiàn)、實(shí)驗(yàn)室檢查、影像學(xué)、微栓子監(jiān)測(cè)檢查特點(diǎn),探討其可能的發(fā)病機(jī)制。方法納入以急性多發(fā)性腦梗死為首發(fā)表現(xiàn)的隱匿性軀體惡性腫瘤患者12例,收集其臨床資料,分析其實(shí)驗(yàn)室血液學(xué)、頭顱MRI、微栓子監(jiān)測(cè)結(jié)果及其治療和預(yù)后。結(jié)果所有患者均以局灶性神經(jīng)功能缺損為主要表現(xiàn),包括偏癱、失語(yǔ)、偏身感覺(jué)障礙、構(gòu)音障礙、眩暈、肢體抽搐等。頭顱DWI示急性多發(fā)腦梗死,病灶播散性分布,不符合單支動(dòng)脈供血區(qū),同時(shí)累及雙側(cè)前循環(huán)或前后循環(huán)。11例行D-dimer檢查者8例升高。7例行微栓子監(jiān)測(cè)有5例陽(yáng)性。隱匿性軀體惡性腫瘤包括:肺癌5例,胰腺癌3例,胃癌、結(jié)腸癌、子宮內(nèi)膜癌、轉(zhuǎn)移性低分化粘液腺癌原發(fā)腫瘤部位不明各1例;診斷時(shí)就已有遠(yuǎn)處轉(zhuǎn)移者10例。病程中缺血性卒中復(fù)發(fā)者7例,急性心肌梗死4例,住院期間死亡3例,預(yù)后差。結(jié)論對(duì)于不符合單支動(dòng)脈供血區(qū)的多發(fā)急性腦梗死,需要考慮可能合并隱匿性軀體惡性腫瘤,凝血功能篩查高凝狀態(tài)和微栓子陽(yáng)性可能是診斷提示線索。
[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.
【作者單位】： 北京大學(xué)第一醫(yī)院神經(jīng)內(nèi)科;中日友好醫(yī)院干部醫(yī)療科;中日友好醫(yī)院神經(jīng)內(nèi)科;
【分類號(hào)】：R743.3;R73

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