Klein P, Haley E C, Wooten G F, VandenBerg S R
Department of Neurology, University of Virginia School of Medicine, Charlottesville.
Arch Neurol. 1989 Oct;46(10):1149-52. doi: 10.1001/archneur.1989.00520460145030.
Diffuse carcinomatous leptomeningeal metastases "carcinomatous meningitis") have the usual clinical course involving multifocal nerve root deficits and a variable diffuse encephalopathy. In contrast, we describe a patient with carcinomatous leptomeningeal metastases who presented with clinical signs of meningitis and focal cerebral infarction. Over an 8-month period, multiple cerebral infarctions and cranial neuropathies developed. Postmortem examination of the patient's brain revealed diffuse leptomeningeal infiltration by a signet-ring adenocarcinoma. The extensive involvement of the subarachnoid space with tumor was associated with dense neoplastic infiltration of the Virchow-Robin spaces. These perivascular tumor infiltrates were accompanied by multifocal mural invasion and, less frequently, by intravascular tumor cells obliterating the lumen. Focal hemorrhagic infarcts in the cerebral cortex corresponded to areas of microscopic vasculopathy. This case provides evidence that tumor-associated vasculopathy with resultant ischemia plays a role in the pathogenesis of focal cerebral infarctions in carcinomatous leptomeningeal metastases.
弥漫性癌性软脑膜转移（“癌性脑膜炎”）通常具有多灶性神经根功能缺损和多变的弥漫性脑病的临床病程。相比之下，我们描述了一名患有癌性软脑膜转移的患者，其表现为脑膜炎和局灶性脑梗死的临床症状。在8个月的时间里，出现了多发性脑梗死和颅神经病变。对该患者脑部进行尸检发现，印戒腺癌弥漫性浸润软脑膜。肿瘤广泛累及蛛网膜下腔，并伴有Virchow-Robin间隙的密集肿瘤浸润。这些血管周围肿瘤浸润伴有多灶性血管壁侵犯，较少见的是血管腔内有肿瘤细胞阻塞管腔。大脑皮质的局灶性出血性梗死对应于微血管病变区域。该病例提供了证据，表明肿瘤相关血管病变导致的缺血在癌性软脑膜转移中局灶性脑梗死的发病机制中起作用。
