Züchner S, Kawohl W, Sellhaus B, Mull M, Mayfrank L, Kosinski C M
Department of Neurology, Aachen University Hospital, Aachen, Germany.
J Neurol Neurosurg Psychiatry. 2003 Mar;74(3):364-6. doi: 10.1136/jnnp.74.3.364.
Ischaemic stroke attributable to malignant brain tumour is a rarely reported phenomenon and even various imaging techniques including angiography do not necessarily lead to an accurate diagnosis.
A 46-year-old, previously healthy man developed apoplectic symptoms with slight right sided hemiparesis and global aphasia. The computed tomography (CT) scan showed lesions of the left temporal lobe and the paraventricular white matter suggestive of left middle cerebral artery (MCA) infarction. Carotid angiography demonstrated compression of the M1 segment of the MCA and occlusion of temporal MCA. The patient initially refused magnetic resonance imaging (MRI) because of claustrophobia. Because of fluctuating symptoms and successive worsening of the condition over weeks an MRI scan was conducted under general anaesthesia. Beneath temporal, opercular, and subcortical infarctions it revealed a left temporal tumour. A tumour biopsy disclosed a gliosarcoma (WHO grade IV). Microscopical examination of the surgical specimen demonstrated invasion of tumour cells into the wall of a greater pre-existing blood vessel.
Malignant brain tumours may cause ischaemic infarction. This is a rare but important differential diagnosis for the origin of strokes. The authors describe the first case with infiltration of intracranial blood vessels by tumour cells of a gliosarcoma.
由恶性脑肿瘤引起的缺血性卒中是一种鲜有报道的现象，即便包括血管造影术在内的各种成像技术也不一定能得出准确诊断。
一名46岁、既往健康的男性出现中风症状，伴有轻微右侧偏瘫和完全性失语。计算机断层扫描（CT）显示左颞叶和脑室旁白质有病变，提示左大脑中动脉（MCA）梗死。颈动脉血管造影显示MCA的M1段受压，颞叶MCA闭塞。该患者最初因幽闭恐惧症拒绝接受磁共振成像（MRI）检查。由于症状波动且病情在数周内持续恶化，遂在全身麻醉下进行了MRI扫描。除了颞叶、岛盖和皮质下梗死外，还发现了左侧颞叶肿瘤。肿瘤活检显示为胶质肉瘤（世界卫生组织IV级）。对手术标本的显微镜检查表明，肿瘤细胞侵入了一条先前存在的较大血管壁。
恶性脑肿瘤可能导致缺血性梗死。这是一种罕见但对卒中病因很重要的鉴别诊断。作者描述了首例胶质肉瘤肿瘤细胞浸润颅内血管的病例。
