Iguchi Yohei, Mano Kazuo, Goto Yoji, Nakano Tomonobu, Nomura Fumio, Shimokata Tomoya, Iwamizu-Watanabe Sachiko, Hashizume Yoshio
Department of Neurology Medicine, Japanese Red Cross Nagoya First Hospital, 3-35 Michishitacho, Nakamuraku, Nagoya, Aichi 453-8511, Japan.
Neuroradiology. 2007 Jan;49(1):35-9. doi: 10.1007/s00234-006-0152-6. Epub 2006 Nov 14.
Miliary dissemination is a rare form of brain metastasis. The clinical and pathologic features of this form are unclear.
We report a 66-year-old man with miliary brain metastases from adenocarcinoma of the lung, describing MRI and neuropathologic findings in the context of previously reported cases.
Initial disorientation progressed to an apallic state within 6 months. Although, CT with administration of contrast agent failed to demonstrate any lesions, MRI with Gd-DTPA administration showed multiple enhancing miliary nodules in the cerebral cortex, basal ganglia, thalamus, cerebellum, and brainstem. Some of those nodules also could be seen on T2-weighted imaging without Gd-DTPA, but were difficult to identify conclusively. A histopathologic examination at autopsy disclosed diffusely distributed miliary tumor nodules in a perivascular distribution without surrounding focal edema or reactive gliosis. Notably, this patient with miliary brain metastases developed disorientation followed by unconsciousness, which overshadowed other focal neurologic signs at that time.
We should consider this pattern of brain dissemination when a cancer is associated with unexplained disturbance of consciousness.
粟粒性播散是脑转移的一种罕见形式。这种形式的临床和病理特征尚不清楚。
我们报告了一名66岁患有肺腺癌粟粒性脑转移的男性患者，结合先前报道的病例描述了MRI和神经病理学发现。
最初的定向障碍在6个月内进展为去大脑皮质状态。尽管增强CT未能显示任何病变，但静脉注射钆喷酸葡胺（Gd-DTPA）的MRI显示大脑皮质、基底神经节、丘脑、小脑和脑干有多个强化的粟粒样结节。其中一些结节在未注射Gd-DTPA的T2加权成像上也可见，但难以明确识别。尸检时的组织病理学检查显示粟粒样肿瘤结节呈血管周围弥漫性分布，无周围局灶性水肿或反应性胶质增生。值得注意的是，这名患有粟粒性脑转移的患者先是出现定向障碍，随后昏迷，当时掩盖了其他局灶性神经体征。
当癌症伴有无法解释的意识障碍时，我们应考虑这种脑播散模式。
