摘要
目的大脑淋巴瘤病是原发性中枢神经系统淋巴瘤的特殊类型，以白质病变为主。国内尚未见该类型报道。我们报道1例大脑淋巴瘤病的临床诊治经过，结合文献复习，提高对该病的认识。方法2015年1月19日患者入院起，追踪和观察患者的病史、临床表现、体格检查和辅助检查，分析大脑淋巴瘤病的临床资料、影像学、神经病理及其对激素和放射治疗的反应。结果该病例表现为进行性认知减退、走路不稳和进行性意识障碍，影像学表现为双侧半球弥漫的白质病变，病变还累及基底节、丘脑、脑干、小脑，并伴有针尖样强化。甲泼尼龙1g／d×5d治疗后病情有好转。后经立体定向活体组织检查证实为B细胞来源的大脑淋巴瘤病。再次以认知和意识障碍时表现为颅内占位性病变，经全脑放射治疗明显好转。结论激素可暂时性地缓解大脑淋巴瘤病症状和缩小病变。相关鉴别疾病较多，临床工作中应加注意，尽早行活体组织检查以明确病理诊断。
Objective Lymphomatosis cerebri （LC） is a rare variant of primary central nervous system lymphoma without evidence of a mass lesion. There was no case report in China. We reported our case and reviewed the related literature for early diagnosis and appropriate treatments. Methods Clinical and imaging data, neuropathology results and therapeutic reaction of a patient diagnosed as LC were reviewed retrospectively. Results A 53-year-old woman presented with 6 months of rapidly progressive dementia, personality change and lethargy. Neurological examination showed globally cognitive deficits and bilateral positive Babisnki＇s sign. Brain magnetic resonance imaging revealed diffuse bilateral white matter changes in the cerebral hemispheres and involvement of the brainstem, basal ganglia and thalamus, with needle-like enhancement. Sterotactic biopsy specimen showed diffuse infiltration of B-type malignant lymphoid cells, consistent with LC. Conclusions Corticosteroids could temporarily alleviate symptoms and lesions of LC. Brain bioosies should be early oerformed for the oromot diagnosis and effective treatment.
出处
《中华神经科杂志》
CAS
CSCD
北大核心
2016年第10期764-768,共5页
Chinese Journal of Neurology
关键词
淋巴瘤
磁共振成像
白质
激素
Lymphoma
Magnetic resonance imaging
White matter
Steroids
