Soda Takao, Edagawa Kotaro, Tsuji Kiyoshi, Dehara Makoto, Nakajima Yoshikazu, Ito Mamoru
Department of Neurology, Rinku General Medical Center.
Rinsho Shinkeigaku. 2008 Sep;48(9):646-50. doi: 10.5692/clinicalneurol.48.646.
A 69-year-old woman was admitted to our hospital because of disturbed consciousness. She awoke to a solid mass in her left breast, but it had been present for about 20 years. On arrival to our hospital, she was comatose, and Babinski's reflexes were present bilaterally. She had no paresis or neck stiffness. Her left breast contained a 10 cm x 12 cm node with multiple ulcers. Blood analysis showed she was in a hypercoagulative state. Computed tomography of the brain demonstrated bilateral hypodensities in the thalamus and hyperdensities at the vein of Galen and at the straight sinus. Angiography showed an absence of flow in the inferior sagittal sinus, in the vein of Galen, and in the straight sinus. Thus, she was diagnosed as having a deep cerebral venous thrombosis. She was treated by continuous heparin infusion, and her consciousness improved gradually. The biopsy of her left breast confirmed the presence of a mucinous carcinoma. The hypercoagulative state associated with the carcinoma was considered to be the cause of her deep cerebral venous thrombosis. It is very rare to diagnose deep cerebral venous thrombosis in a cancer patient while the patient is still alive. In this case, computed tomography of the brain was useful for the diagnosis.
一名69岁女性因意识障碍入住我院。她醒来时发现左乳有一实性肿块,该肿块已存在约20年。入院时,她处于昏迷状态,双侧巴氏征阳性。她没有轻瘫或颈部强直。她的左乳有一个10厘米×12厘米的结节,伴有多处溃疡。血液分析显示她处于高凝状态。脑部计算机断层扫描显示双侧丘脑低密度影,大脑大静脉和直窦高密度影。血管造影显示下矢状窦、大脑大静脉和直窦无血流。因此,她被诊断为深部脑静脉血栓形成。她接受了持续肝素输注治疗,意识逐渐改善。她左乳的活检证实存在黏液癌。与癌症相关的高凝状态被认为是她深部脑静脉血栓形成的原因。在癌症患者仍存活时诊断出深部脑静脉血栓形成非常罕见。在这种情况下,脑部计算机断层扫描对诊断很有用。