Takenaka N, Mine T, Takada Y, Uematsu Y, Okuno T, Enomoto K
Department of Neurosurgery, Ashikaga Redcross Hospital, Japan.
No To Shinkei. 1989 Aug;41(8):825-9.
A case of pseudotumor cerebri associated with iron deficiency anemia due to colon cancer is reported in a 37-year-old woman. Her initial symptoms were vomiting and severe headache. On physical examination, no lymph nodes and abdominal mass were palpable but marked anemia was noted in her skin and conjunctiva . Neurological examination revealed papilledema in her both eyes and stiff neck. There was no abnormal findings on CT scan on admission. Spinal puncture revealed CSF pressure as high as 620 mmH2O with normal cells, protein, sugar and chloride levels. Hematological examination revealed iron deficiency anemia and thrombocytosis. Angiography at third day revealed no sinus occlusion, but retention of contrast media was seen on the cortical vein of parietal lobe and right transverse sinus. Brain scintigram at sixth day revealed mild accumulation in left parietal lobe, so small venous infarction was suggested. There were two circumscribed stenotic lesions of right ascending colon in the barium enema, and right hemicolectomy was achieved. The pathological diagnosis was adenocarcinoma. The symptoms of pseudotumor cerebri was completely disappeared soon after the surgery together with resolution of anemia. She lives with no deficits now 1 year 3 months after surgery. In conclusion much attention is necessary to a patient of pseudotumor cerebri with iron deficiency anemia for the presence of cancer, because not only this central nervous system lesion is reversible and curable but also the cancer itself may be curable by surgery.
报告了一名37岁女性因结肠癌伴缺铁性贫血引发的假脑瘤病例。她最初的症状是呕吐和严重头痛。体格检查时,未触及淋巴结和腹部肿块,但发现其皮肤和结膜有明显贫血。神经学检查显示她双眼视乳头水肿且颈部僵硬。入院时CT扫描未发现异常。腰椎穿刺显示脑脊液压力高达620毫米水柱,细胞、蛋白质、糖和氯化物水平正常。血液学检查显示缺铁性贫血和血小板增多。第三天的血管造影显示无静脉窦闭塞,但在顶叶皮质静脉和右横窦可见造影剂滞留。第六天的脑闪烁扫描显示左顶叶有轻度积聚,提示有小静脉梗死。钡灌肠显示右半升结肠有两个局限性狭窄病变,遂进行了右半结肠切除术。病理诊断为腺癌。术后假脑瘤症状很快完全消失,贫血也得到缓解。术后1年3个月,她目前生活无任何缺陷。总之,对于患有缺铁性贫血的假脑瘤患者,必须高度关注是否存在癌症,因为不仅这种中枢神经系统病变是可逆且可治愈的,而且癌症本身也可能通过手术治愈。