Hideyama Takuto, Tanaka Hiroshi, Uesaka Yoshikazu, Kunimoto Masanari, Miwa Akiyoshi
Department of Neurology, International Medical Center of Japan.
Rinsho Shinkeigaku. 2008 Jun;48(6):415-8. doi: 10.5692/clinicalneurol.48.415.
A 73-year-old woman was admitted to the surgical department of our hospital for endoscopic resection of a colonic polyp. The day after endoscopic resection, she became drowsy and dysphasic. Two days later, left hemiparesis and gait difficulty developed. The next day, hemiparesis progressed bilaterally and dyspnea developed due to upper airway stenosis. The most prominent signs were those of bulbar palsy. Blood analysis revealed mild inflammatory responses and hyponatremia. T2-weighted magnetic resonance imaging showed high-intensity lesions in the swollen medulla and cervical spinal cord. Those areas and the meninges of the posterior fossa were enhanced by gadolinium. Steroid pulse therapy was administered, resulting in rapid recovery of bulbar and paretic symptoms with decreased enhanced area. At this point, concentration of cerebrospinal fluid interleukin (IL)-10 was markedly elevated at 146 pg/ml (normal,< 5 pg/ml), suggesting malignant lymphoma. Cytology of the cerebrospinal fluid was repeatedly examined, eventually revealing atypical lymphocytes with hyperlobulated nuclei and clear nucleoli. Lymphocytes stained with anti-CD20 antibody. These findings strongly suggested a diagnosis of primary intraocular and central nervous system lymphoma. In the present case, repeated cytology of cerebrospinal fluid was highly important for diagnosis in this case of high IL-10 level in cerebrospinal fluid.
一名73岁女性因结肠息肉内镜切除入住我院外科。内镜切除术后第二天，她出现嗜睡和言语困难。两天后，出现左侧偏瘫和步态障碍。次日，偏瘫双侧进展，因上呼吸道狭窄出现呼吸困难。最突出的体征是延髓麻痹。血液分析显示轻度炎症反应和低钠血症。T2加权磁共振成像显示延髓和颈髓肿胀处有高强度病变。钆增强扫描显示这些区域以及后颅窝脑膜有强化。给予类固醇冲击治疗后，延髓和麻痹症状迅速恢复，强化区域缩小。此时，脑脊液白细胞介素（IL）-10浓度显著升高至146 pg/ml（正常，<5 pg/ml），提示恶性淋巴瘤。反复检查脑脊液细胞学，最终发现核分叶过多且核仁清晰的非典型淋巴细胞。淋巴细胞用抗CD20抗体染色。这些发现强烈提示原发性眼内和中枢神经系统淋巴瘤的诊断。在本病例中，脑脊液白细胞介素-10水平较高，反复进行脑脊液细胞学检查对诊断非常重要。
