Leptomeningeal carcinomatosis following neoplastic cerebral aneurysm rupture: a case report.
Leptomeningeal carcinomatosis following neoplastic cerebral aneurysm rupture: a case report.
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肿瘤性脑动脉瘤破裂后的软脑膜癌病：病例报告。
DOI：
10.1016/j.wneu.2019.02.058
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发表时间：
2019
期刊：
影响因子：
--
通讯作者：
Morioka M.
中科院分区：
文献类型：
--
作者：
Koga M;Aoki T;Negoto T;Makizono T;Sugi K;Fujimori K;Kajiwara S;Komaki S;Yoshitomi M;Sugita Y;Morioka M.
软脑膜癌病中原发肿瘤向软脑膜扩散存在几种可能的机制。这份报告描述了一个案件所造成的直接出血在蛛网膜下腔的肿瘤性脑动脉瘤rupture.Case DescriptionA 48岁的日本妇女，谁被诊断为乳腺癌（pT 3 pN 2 M0）在45岁的年龄，并进行乳房切除术和化疗，被承认在昏迷后突然发作的严重头痛。计算机断层扫描显示蛛网膜下腔弥漫性出血，血管造影显示大脑中动脉远端动脉瘤。在入院后24小时内进行了颞浅动脉-大脑中动脉搭桥术、脑动脉瘤夹闭术和动脉瘤切除术。AE 1/AE 3染色显示囊壁中具有高核质比的非典型细胞聚集。在显示出初步改善后，她在第45天由于复杂的心室扩大而出现意识障碍。虽然急性期的脑脊液没有非典型细胞，但随后的检测显示非典型细胞，这支持了由于乳腺癌扩散导致的软脑膜癌病的诊断。患者在接受标准内分泌治疗和放射治疗后第78天死亡。ConclusionsTumor细胞通过血行播散或直接从既存病变延伸至软脑膜，并可通过脑脊液进行神经轴播散。蛛网膜下腔出血和软脑膜癌病都是具有极差预后的破坏性疾病。该患者出现延迟性意识障碍软脑膜癌病伴体力状态下降，这使得难以根据其不良预后证明积极治疗的合理性。
BackgroundSeveral possible mechanisms exist for the spread of a primary tumor to the leptomeninges in leptomeningeal carcinomatosis. This report describes a case caused by direct bleeding in the subarachnoid space from a neoplastic cerebral aneurysm rupture.Case DescriptionA 48-year-old Japanese woman, who was diagnosed with breast carcinoma (pT3 pN2 M0) at the age of 45 years and underwent mastectomy and chemotherapy, was admitted in a coma following a sudden-onset severe headache. Computed tomography revealed diffuse hemorrhage in the subarachnoid space, and angiography revealed an aneurysm at the distal middle cerebral artery. Superficial temporal artery−middle cerebral artery bypass, aneurysmal trapping, and aneurysm resection were performed within 24 hours of admission. Staining for AE1/AE3 revealed accumulation of atypical cells with a high nuclear-cytoplasmic ratio in the aneurysmal wall. After showing initial improvement, she developed disturbed consciousness due to complicated ventricular enlargement on day 45. Although the cerebrospinal fluid in the acute phase had no atypical cells, subsequent testing revealed atypical cells, which supported a diagnosis of leptomeningeal carcinomatosis due to breast cancer dissemination. The patient died on day 78 after receiving standard endocrine therapy and radiation therapy.ConclusionsTumor cells reach the leptomeninges via hematogenous spread or direct extension from preexisting lesions and can undergo neuraxis dissemination via the cerebrospinal fluid. Subarachnoid hemorrhage and leptomeningeal carcinomatosis are both devastating conditions with extremely poor prognoses. This patient experienced delayed disturbed consciousness leptomeningeal carcinomatosis with decreased performance status, which made it difficult to justify aggressive treatment on the basis of her poor prognosis.
远端大脑中动脉动脉瘤破裂的临床特征：文献综述
影响因子：
2
作者：
K. Tsutsumi;T. Horiuchi;Alhusain Nagm;Y. Toba;K. Hongo
通讯作者：
K. Hongo
影响因子：
4.8
作者：
Kazuhiro Tanaka;H. Minami;Masaaki Kota;K. Kuwamura;E. Kohmura
通讯作者：
E. Kohmura