Burgetova Andrea, Seidl Zdenek, Vaneckova Manuela, Jakoubkova Michaela
Department of Radiology, 1st Medical Faculty, Charles University, Prague, Czech Republic.
Neuro Endocrinol Lett. 2008 Dec;29(6):867-70.
We present the patient with the diagnosis of multiple sclerosis (MS), relapsing-remitting form with long lasting remission. Unexpectedly, this patient presented dramatical clinical deterioration and revealed clinical symptoms such as bradypsychia, cognitive symptoms, central vestibulare syndrome, spastic quadruparesis. Clinical findings suggested secondary progressive MS, but MRI called in question this diagnosis. The MRI appearance suggested, that MS had been complicated by a different brain pathological lesion, and the brain biopsy was indicated. A histological examination confirmed primary CNS lymphoma (PCNSL). This case exemplifies important aspects of clinical neurology. A re-evaluation of the diagnosis of MS should always be performed in a patient when new symptoms are presented that are unusual or could be due to other pathological processes. MRI offers the highly sensitive way to detect the coexistence of MS and other brain disease. Primary goal of imaging modalities is differential diagnosis between demyelinating diseases, such as MS and other brain lesions. Advanced focus demand contrast- enhancing and mass- effect lesions. It is important to realize, that contrast-enhancement and brain edema may be mitigated by treatment with corticosteroids. In some cases a brain biopsy is needed.
我们诊断该患者患有多发性硬化症（MS），复发缓解型，缓解期持续较长。出乎意料的是，该患者出现了显著的临床恶化，并表现出诸如精神迟缓、认知症状、中枢前庭综合征、痉挛性四肢瘫等临床症状。临床检查结果提示为继发进展型MS，但MRI对这一诊断提出了质疑。MRI表现提示，MS合并了另一种不同的脑部病理病变，因此需要进行脑活检。组织学检查证实为原发性中枢神经系统淋巴瘤（PCNSL）。该病例体现了临床神经学的重要方面。当患者出现不寻常或可能由其他病理过程导致的新症状时，应始终对MS诊断进行重新评估。MRI是检测MS与其他脑部疾病共存的高度敏感方法。影像学检查的主要目的是鉴别脱髓鞘疾病，如MS与其他脑部病变。重点关注强化和占位效应病变。重要的是要认识到，使用皮质类固醇治疗可能会减轻强化和脑水肿。在某些情况下，需要进行脑活检。
