Clinic for Hematology, Clinical Center Serbia, Koste Todorovica 2, 11000 Belgrade, Serbia.
Neurol Sci. 2012 Apr;33(2):387-90. doi: 10.1007/s10072-011-0726-x. Epub 2011 Aug 6.
A 60-year-old woman with no previous history of chronic disease or malignancy presented with intense back and left leg pain and sleep disturbances. The patient had been treated unsuccessfully for the past 6 months with analgetics. Magnetic resonance imaging showed a soft tissue tumor in the L5-S1 region that involved the spinal canal, and a pathohistological analysis of the tumor specimen confirmed the presence of non-Hodgkin, diffuse large B cell lymphoma. After the diagnosis was confirmed, malaise, nausea, and vomiting developed. Multislice computed tomography of the endocranium showed focal infiltration of the hypothalamus and lateral ventricle; dissemination of a systemic lymphoma was excluded. Therapy was initiated as per the De Angelis protocol. After intravenous and intrathecal administration of metotrexate, the patient developed signs of central diabetes insipidus, which responded to therapy with an antidiuretic hormone analog. Despite the obvious infiltration of the hypothalamus, we cannot exclude an idiosyncratic effect of methotrexate on the central diabetes insipidus.
一位 60 岁女性，无慢性病史或恶性病史，表现为剧烈的背痛和左腿痛以及睡眠障碍。过去 6 个月，患者一直在接受镇痛药治疗，但效果不佳。磁共振成像显示 L5-S1 区域有一个累及椎管的软组织肿瘤，肿瘤标本的病理分析证实存在非霍奇金弥漫性大 B 细胞淋巴瘤。确诊后，患者出现不适、恶心和呕吐。颅内腔的多层计算机断层扫描显示下丘脑和侧脑室有局灶性浸润；排除了全身性淋巴瘤的扩散。根据 De Angelis 方案开始治疗。静脉和鞘内注射甲氨蝶呤后，患者出现中枢性尿崩症的迹象，用抗利尿激素类似物治疗后得到缓解。尽管下丘脑明显浸润，但我们不能排除甲氨蝶呤对中枢性尿崩症的特发性作用。
