McKinnon Chris, Manchanda Simmie
Division of Integrated Elderly Medicine & Community Care, Buckinghamshire Healthcare NHS Trust, High Wycombe, UK.
BMJ Case Rep. 2017 May 24;2017:bcr-2016-218088. doi: 10.1136/bcr-2016-218088.
Acute confusion is a common symptom of physical illness in the older patient. In the majority, it is transient and resolves on treatment of precipitants. In a subset of patients, however, neurological decline is progressive, raising concern about a serious underlying cause. We describe the case of a 71-year-old woman who developed progressive cognitive impairment following insertion of a permanent pacemaker for sinoatrial arrests. An initial diagnosis of delirium secondary to a urinary tract infection was suspected; however, the patient became increasingly confused despite treatment. Laboratory tests revealed serum anti-Hu paraneoplastic antibodies, and CT chest identified an occult lung tumour. Cervical lymph node histopathology confirmed a diagnosis of small cell carcinoma of the lung. Although a rare cause of confusion, paraneoplastic encephalomyelitis should be recognised early to allow timely identification and treatment of the associated cancer.
急性意识模糊是老年患者身体疾病的常见症状。大多数情况下，它是短暂的，在治疗诱因后会消退。然而，在一部分患者中，神经功能衰退是渐进性的，这引发了对严重潜在病因的担忧。我们描述了一名71岁女性的病例，她在因窦性停搏植入永久性起搏器后出现了进行性认知障碍。最初怀疑是继发于尿路感染的谵妄；然而，尽管进行了治疗，患者的意识却越来越模糊。实验室检查发现血清抗Hu副肿瘤抗体，胸部CT发现一个隐匿性肺肿瘤。颈部淋巴结组织病理学确诊为肺小细胞癌。尽管副肿瘤性脑脊髓炎是意识模糊的罕见原因，但应尽早识别，以便及时发现并治疗相关癌症。
