PERIPHERAL NEURITIS IN MYELOMATOSIS
PERIPHERAL NEURITIS IN MYELOMATOSIS
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DOI：
10.1136/bmj.2.4996.802
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发表时间：
1956-01-01
影响因子：
--
通讯作者：
CROW, RS
中科院分区：
文献类型：
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作者：
CROW, RS
骨髓瘤病中神经系统病变的发生率很高。 Geschickter 和 Copeland (1928) 报道了 425 例中的 40%，Batts (1939) 报道了 40 例中的 35%，Adams 等人 (1949) 报道了 61 例中的 35%，Snapper 等人 (1953) 报道了 97 例中的 40%。最常见的病变类型是病理性骨折或肿瘤块对神经组织或其血液供应的直接压迫（Davison 和 Balser，1937；Clarke，1954）。有时，由于血清球蛋白的严重异常，会发生血管血栓或出血（Wintrobe 和 Buell，1953；Marshall 和 Malone，1954）。很少有脑膜以及颅神经或周围神经通过肿瘤组织的直接扩散而被浸润（Sparling 等，1947）。骨髓瘤的髓外沉积物已在大多数器官中发现，但在神经组织中尚未有报道。与这些机械或血管病变不同，周围神经炎也发生在骨髓瘤病中。 Senator (1899) 报告了一例延髓麻痹病例，但未找到解剖学原因。 Scheinker (1938) 描述了一名 39 岁男性的病例，该男性患有胸骨孤立性骨髓瘤，并伴有疼痛的进行性周围神经炎。该患者的前胸壁上还出现了两大块增厚、色素沉着的皮肤。沙因克假设骨髓瘤组织有一种特定的“有毒”代谢物，会影响皮肤和周围神经，他认为在许多情况下，骨髓瘤病的疼痛是由于神经的“毒性疾病”造成的。 Davison 和 Balser (1937) 报道了一名 49 岁女性的多发性骨髓瘤病例，她患有主要影响手臂的疼痛性周围神经炎。患有缺铁性贫血（血红蛋白50%），他们将神经病变归因于“严重继发性贫血”或“未知毒性因素”。 Kurnick 和 Yohalem (1948) 在两例多发性骨髓瘤病中描述了广泛的疼痛性周围神经炎，并认为这种神经病变与“某些代谢性疾病，如糖尿病和恶性贫血”中发生的神经病变相当。 Snapper等人（1953）提到了四例“手套和袜子”型周围神经炎的病例，还有几例显示“骨间肌和手臂肌肉组织显着萎缩，而没有其他神经系统受累的证据”。布鲁尔（Brewer，1948）的一个病例“手脚有些感觉丧失”。本文的目的是报告另外两例伴有周围神经炎和其他显着特征的骨髓瘤病病例。病例1 1953年5月，一名54岁的已婚男子，从事货车司机工作，在没有外伤的情况下，突然出现右肩疼痛和活动受限。这些症状在几周内消退，但轻微的间歇性疼痛仍然存在。大约 1953 年底出现无痛肿胀
In myelomatosis there is a high incidence of neurological lesions. Neurological abnormalities were reported by Geschickter and Copeland (1928) in 40% of 425 cases, by Batts (1939) in 35% of 40 cases, by Adams et al.(1949) in 35% of 61 cases, and by Snapper et al.(1953) in 40% of 97 cases. The commonest type of lesion is direct compression of nervous tissue or its blood supply by a pathological fracture or tumour mass (Davison and Balser, 1937; Clarke, 1954). Occasionally vascular thromboses or haemorrhages due to gross abnormality of serum globulin occur (Wintrobe and Buell, 1953; Marshall and Malone, 1954). Rarely the meninges, and with them cranial or peripheral nerves, are infiltrated by direct spread from tumour tissue (Sparling et al., 1947). Extramedullary deposits of myeloma, which have been found in most organs, have not been reported in nervous tissue. Peripheral neuritis, distinct from these mechanical or vascular lesions, also occurs in myelomatosis. Senator (1899) reported a case with bulbar palsy for which no anatomical cause was found. Scheinker (1938) described the case of a man of 39 with a solitary myeloma of the sternum who had a painful progressive peripheral neuritis. This patient also developed two large patches of thickened, deeply pigmented skin on the anterior chest wall. Scheinker postulated a specific" toxic" metabolite of myelomatous tissue which affected skin and peripheral nerves, and he suggested that in many cases the pain of myelomatosis is due to a" toxic disease" of the nerves. Davison and Balser (1937) reported a case of multiple myelomatosis in a woman of 49 who had a painful peripheral neuritis mainly affecting the arms. There was an iron-deficiency anaemia (haemoglobin 50%), and they attributed the neuropathy to the" severe secondary anaemia" or to" unknown toxic factors." Kurnick and Yohalem (1948) described extensive painful peripheral neuritis in two cases of multiple myelomatosis, and regarded the neuropathy as comparable with that which occurs in" some metabolic diseases such as diabetes and pernicious anaemia." Snapper et al.(1953) mention four cases with" glove and stocking" type of peripheral neuritis, and also several cases showing" striking atrophy of the interosseous muscles and the musculature of the arms without other evidence of neurological involvement." One of Brewer's (1948) cases had" some loss of feeling in the hands and feet." The purpose of this paper is to report two further cases of myelomatosis with peripheral neuritis and other striking features. Case 1In May, 1953, a married man aged 54, who worked as a lorry driver, developed sudden pain and limitation of move-ment in the right shoulder without preceding trauma. These symptoms subsided in a fewweeks, but mild intermittent pain persisted. About the end of 1953 a painless swelling