University of Medicine and Pharmacy Targu Mures, Department of Neurology, Romania.
University of Medicine and Pharmacy Targu Mures, Department of Neurology, Romania.
Neurol Neurochir Pol. 2017 Nov-Dec;51(6):510-513. doi: 10.1016/j.pjnns.2017.08.004. Epub 2017 Aug 18.
A 57-year-old patient was admitted to the Neurology Clinic for hypoesthesia, intense pain in the right chin and double vision. During the hospitalization, the patient developed progressive complete bilateral ophthalmoplegia and numbness of both sides of the chin. Brain CT and MRI scans with gadolinium were normal. Standard laboratory tests on admission were normal. The cerebral spinal fluid examination and the infectious and autoimmune workup were also normal. A thoracic-abdominal and pelvic CT scan revealed two hypodense lesions in the liver, irregular thickening of the gastric and ileal wall, and multiple abdominal adenopathies. Meanwhile, the patient developed marked fatigue, fever, sweats, nausea, vomiting and abdominal pain. An exploratory laparotomy was performed that showed multiple tumours of the small intestinal wall, stomach wall, multiple liver masses in both lobes and appendicular tumour. Histopathological findings of the liver biopsy and appendicular walls revealed Burkitt lymphoma. The patient died two days after surgery by cardiopulmonary arrest. This case underscores the importance of keeping BL in the differential diagnosis of patients with rapidly progressive ophthalmoplegia and numb chin syndrome, with normal brain MRI and CSF examinations.
一位 57 岁患者因感觉减退、右侧下巴剧痛和复视而被收入神经内科病房。住院期间，患者逐渐出现双侧完全性眼肌瘫痪和下巴两侧麻木。脑 CT 和钆增强 MRI 扫描正常。入院时的标准实验室检查正常。脑脊髓液检查和感染及自身免疫检查也正常。胸部、腹部和盆腔 CT 扫描显示肝脏有两个低密病灶，胃和回肠壁不规则增厚，以及多个腹部淋巴结肿大。同时，患者出现明显的乏力、发热、出汗、恶心、呕吐和腹痛。进行了剖腹探查术，显示小肠壁、胃壁有多发性肿瘤，肝脏两叶和阑尾均有肿瘤。肝脏活检和阑尾壁的组织病理学检查显示 Burkitt 淋巴瘤。患者在手术后两天因心肺骤停死亡。本病例强调了在快速进展性眼肌瘫痪和下巴麻木综合征患者的鉴别诊断中保持 BL 的重要性，即使脑 MRI 和 CSF 检查正常也是如此。
