Teare J P, Whitehead M, Rake M O, Coker R J
Department of Medicine, Kent and Canterbury Hospital, UK.
Postgrad Med J. 1991 Oct;67(792):909-11. doi: 10.1136/pgmj.67.792.909.
We report a 49 year old man who presented with left leg weakness, frontal headache, impaired concentration and dysphagia. He was thought to have a benign oesophageal stricture on barium swallow and oesophagoscopy though this was not initially biopsied. During admission his vision deteriorated so that he could only recognize bright light. Repeat oesophagoscopy demonstrated an oesophageal adenocarcinoma. The diagnosis of meningeal carcinomatosis was confirmed at post-mortem. Sudden bilateral blindness is a common feature of meningeal carcinomatosis but, as this is rare, it is not commonly considered in the differential diagnosis of visual loss. The visual loss can be explained by vascular insufficiency in association with tumour cuffing of the subarachnoid space of the optic nerve sheath, by neuronal toxins, or other, as yet unknown, mechanisms.
我们报告了一名49岁男性，他出现左腿无力、前额头痛、注意力不集中和吞咽困难。钡餐造影和食管镜检查显示他被认为患有良性食管狭窄，不过最初未进行活检。住院期间，他的视力恶化，以至于只能识别亮光。再次食管镜检查显示为食管腺癌。尸检证实为脑膜癌病。突然双侧失明是脑膜癌病的常见特征，但由于这种情况罕见，在视力丧失的鉴别诊断中通常不会被考虑。视力丧失可以用与视神经鞘蛛网膜下腔肿瘤包绕相关的血管供血不足、神经元毒素或其他尚未明确的机制来解释。
