Niwa J, Suetake K, Okuyama T, Shimizu K, Hirai H
Department of Neurosurgery, Hakodate Municipal Hospital, Japan.
No To Shinkei. 1991 Dec;43(12):1151-5.
A case of cauda equina neurinoma associated with intracranial hypertension is reported. A 59-year-old female with a history of disturbed orientation was admitted. A neurological examination upon admission revealed the disorientation and gait disturbance. Superficial sensation under L3 was impaired. A computed tomographic(CT) scan presented the enlargement of ventricles and the slightly poor description of cerebral sulci. Since the patient had a high fever up to 40.1 C, meningitis was suspected. Cerebrospinal fluid revealed that cell count was only 2/3, while the protein concentration was markedly elevated (389mg/dl). Froin reaction was extremely positive and fibrin was observed. Based upon these findings, the spinal tumor was considered. Plain lumber film showed the posterior scalloping of the L5 and S1 vertebral bodies. Gd-DTPA enhanced MRI showed a high signal intensity area at the cauda equina. Diagnosed as a cauda equina tumor, the total resection of the tumor was performed via laminectomy of L3-S1. The tumor was involved with nerve filaments at the cauda equina. The pathological diagnosis was neurinoma. After the operation, her symptoms improved and a CT scan revealed the reduction of the ventricular size. However, the protein concentration of cerebrospinal fluid did not normalized.
报告一例马尾神经鞘瘤合并颅内高压的病例。一名有定向障碍病史的59岁女性入院。入院时神经系统检查发现定向障碍和步态障碍。L3以下浅感觉受损。计算机断层扫描(CT)显示脑室扩大,脑沟显示略模糊。由于患者高热达40.1℃,怀疑有脑膜炎。脑脊液检查显示细胞计数仅为2/3,而蛋白质浓度明显升高(389mg/dl)。弗洛因反应极为阳性,可见纤维蛋白。基于这些发现,考虑为脊髓肿瘤。腰椎平片显示L5和S1椎体后缘呈扇贝样改变。钆喷酸葡胺增强磁共振成像显示马尾神经处有高信号区。诊断为马尾神经肿瘤,经L3-S1椎板切除术对肿瘤进行了全切除。肿瘤累及马尾神经细丝。病理诊断为神经鞘瘤。术后患者症状改善,CT扫描显示脑室大小缩小。然而,脑脊液中的蛋白质浓度并未恢复正常。