Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Gudrunstrasse 56, Bochum 44791, Germany.
J Clin Neurosci. 2012 Dec;19(12):1723-5. doi: 10.1016/j.jocn.2011.12.029. Epub 2012 Sep 16.
We present a 77-year-old previously well patient with facial asymmetry and progressive weakness of the lower extremities. An initial MRI revealed slight contrast enhancement of the meninges. Three consecutive cerebrospinal fluid examinations demonstrated low glucose concentration, marked elevation of total protein and moderate pleocytosis. No tumor cells, fungi, acid-fast bacilli or mycobacterial DNA were found. The patient's level of consciousness deteriorated dramatically, and follow-up MRI showed widespread extensive cortical hyperintensities. The lesions showed restricted diffusion on diffusion-weighted images as well as low values on the corresponding apparent diffusion coefficient maps, the changes consistent with diffuse cytotoxic edema. Neuropathological examination findings were of leptomeningeal carcinomatosis (LMC) with diffuse continuous infiltration of the cerebral cortex, cerebellum and spinal cord. The autopsy revealed a subcentimetre adenocarcinoma of the lung. To our knowledge, this is the first report demonstrating extensive cortical involvement in adenocarcinomatous LMC.
我们报告了一例 77 岁的既往健康患者，表现为面部不对称和下肢进行性无力。初始 MRI 显示脑膜轻度对比增强。连续 3 次脑脊液检查显示低糖浓度、总蛋白显著升高和中度白细胞增多。未发现肿瘤细胞、真菌、抗酸杆菌或分枝杆菌 DNA。患者的意识水平急剧恶化，随访 MRI 显示广泛的广泛皮质高信号。病变在弥散加权图像上表现为弥散受限，相应的表观弥散系数图上表现为低值，这些变化与弥漫性细胞毒性水肿一致。神经病理学检查结果为脑膜癌病（LMC），大脑皮质、小脑和脊髓弥漫性连续浸润。尸检显示肺亚厘米腺癌。据我们所知，这是首例报道广泛皮质受累的腺癌性 LMC。
