Kahveci Ramazan, Gürer Bora, Kaygusuz Gülşah, Sekerci Zeki
Department of Neurosurgery, Kirikkale Yuksek Ihtisas Hospital, 71450, Kirikkale, Turkey.
J Neurosci Rural Pract. 2012 Sep;3(3):386-9. doi: 10.4103/0976-3147.102638.
"Miliary brain metastases", also termed as "Carcinomatous encephalitis", are an extremely rare form of cerebral metastasis. Here in this article, we report a 52 year-old male patient with miliary brain metastases originating from occult lung adenocarcinoma. There were no significant findings on his initial physical and neurological examinations except limited cooperation. Brain computed tomography revealed edematous regions at the inferior sections of both parietal lobes. Then after, the contrast-enhanced magnetic resonance imaging revealed innumerable multi-dimensional lesions associated with surrounding edema on T2-weighted images. The proton magnetic resonance spectroscopy revealed increases in the choline and lipid peaks with decreased N-acetylaspartate in a similar manner with metastatic brain tumors. Histopathological findings pointed out that malignant epithelial tumor metastasis were originating in primary lung adenocarcinoma. Despite the advances in technical equipments and medical knowledge, miliary metastatic brain tumors are quite rare and the differential diagnosis is difficult. Our aim in this article was to present this rare case in which the lung was thought to be the primary focus; and outline the radiological characteristics. Also, we believe that the findings presented by proton magnetic resonance spectroscopy may contribute to making a differential diagnosis.
“粟粒性脑转移瘤”，也被称为“癌性脑炎”，是一种极为罕见的脑转移形式。在本文中，我们报告了一名52岁男性患者，其粟粒性脑转移瘤源自隐匿性肺腺癌。除了配合度有限外，其初次体格检查和神经学检查未发现明显异常。脑部计算机断层扫描显示双侧顶叶下部存在水肿区域。随后，对比增强磁共振成像在T2加权图像上显示出无数与周围水肿相关的多维病变。质子磁共振波谱显示胆碱和脂质峰升高，N - 乙酰天门冬氨酸降低，与转移性脑肿瘤情况相似。组织病理学检查结果指出，恶性上皮肿瘤转移源自原发性肺腺癌。尽管技术设备和医学知识不断进步，但粟粒性转移性脑肿瘤仍然相当罕见，鉴别诊断困难。本文的目的是呈现这例肺部被认为是原发灶的罕见病例；并概述其放射学特征。此外，我们认为质子磁共振波谱所呈现的结果可能有助于进行鉴别诊断。
