枕骨大孔脑膜瘤：非典型病因导致的吞咽困难。
Foramen magnum meningioma: Dysphagia of atypical etiology.
作者信息
Tsao Gabriel J, Tsang Matthew W, Mobley Bret C, Cheng Walter W
机构信息
School of Medicine, Stanford University, Stanford, CA, USA.
出版信息
J Gen Intern Med. 2008 Feb;23(2):206-9. doi: 10.1007/s11606-007-0474-z. Epub 2007 Dec 15.
INTRODUCTION
We present a case of a foramen magnum meningioma that highlights the importance of the neurologic exam when evaluating a patient with dysphagia. A 58-year-old woman presented with an 18-month history of progressive dysphagia, chronic cough and 30-pound weight loss. Prior gastroenterologic and laryngologic workup was unrevealing.
RESULTS
Her neurologic examination revealed an absent gag reflex, decreased sensation to light touch on bilateral distal extremities, hyperreflexia, and tandem gait instability. Repeat esophagogastroduodenoscopy was normal, whereas laryngoscopy and video fluoroscopy revealed marked hypopharyngeal dysfunction. Brain magnetic resonance imaging demonstrated a 3.1 x 2.7 x 2.9 cm foramen magnum mass consistent with meningioma. The patient underwent neurosurgical resection of her mass with near complete resolution of her neurologic symptoms. Pathology confirmed diagnosis of a WHO grade I meningothelial meningioma.
CONCLUSION
CNS pathology is an uncommon but impressive cause of dysphagia. Our case demonstrates the importance of a thorough neurologic survey when evaluating such a patient.
引言
我们报告一例枕骨大孔脑膜瘤病例，该病例突出了在评估吞咽困难患者时神经系统检查的重要性。一名58岁女性，有18个月进行性吞咽困难、慢性咳嗽病史，体重减轻30磅。先前的胃肠病学和喉科学检查未发现异常。
结果
她的神经系统检查显示咽反射消失、双侧远端肢体轻触觉减退、反射亢进和串联步态不稳。重复食管胃十二指肠镜检查正常，而喉镜检查和视频荧光透视显示下咽功能明显障碍。脑部磁共振成像显示一个3.1×2.7×2.9厘米的枕骨大孔肿块，符合脑膜瘤。患者接受了神经外科手术切除肿块，神经症状几乎完全缓解。病理证实为世界卫生组织I级脑膜上皮型脑膜瘤。
结论
中枢神经系统病变是吞咽困难的一个罕见但显著的原因。我们的病例表明，在评估此类患者时进行全面的神经系统检查很重要。
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