Ishikawa S, Yamazaki M, Nakamura A, Hanyu N
Department of Neurology, Nagano Red-Cross Hospital, Japan.
Rinsho Shinkeigaku. 2000 Mar;40(3):243-8.
A 65-year-old man developed right facial palsy and six months later experienced sudden unconsciousness and right hemiplegia. On admission he had severe nuchal rigidity, decreased visual acuity, and a hearing disturbance. A CT scan and angiography failed to reveal any lesions in the brain, but CSF cytology showed undifferentiated malignant cells with a high level of neuron-specific enolase. A postcontrast CT scan and MRI demonstrated diffuse meningeal enhancement and a faintly rim-enhanced cystic lesion at the cerebellopontine angle. The patient died four months after admission, and postmortem examination revealed meningeal dissemination of squamous cell carcinoma, probably arising from an epidermoid cyst at the cerebellopontine angle. Microscopic examination revealed squamous epithelial debris and a foreign body reaction in portions of the cyst wall and in the surrounding subarachnoid space near the base of the cyst. Rim enhancement of the cyst on MRI and the microscopic findings indicated that the recurrent headaches may have been the result of chemical aseptic meningitis caused by spontaneous leakage of the cyst's contents.
一名65岁男性出现右侧面瘫，6个月后突然意识丧失并出现右侧偏瘫。入院时，他有严重的颈项强直、视力下降和听力障碍。CT扫描和血管造影未发现脑部有任何病变，但脑脊液细胞学检查显示有未分化的恶性细胞，神经元特异性烯醇化酶水平很高。增强CT扫描和MRI显示脑膜弥漫性强化，桥小脑角有一个轻度边缘强化的囊性病变。患者入院4个月后死亡，尸检发现脑膜有鳞状细胞癌播散，可能起源于桥小脑角的表皮样囊肿。显微镜检查显示，囊肿壁的部分区域以及囊肿底部周围蛛网膜下腔有鳞状上皮碎片和异物反应。MRI上囊肿的边缘强化以及显微镜检查结果表明，复发性头痛可能是囊肿内容物自发渗漏引起的化学性无菌性脑膜炎所致。
