Okubo Yoshihiko, Ueta Yuki, Taguchi Takeshi, Kato Haruhisa, Terashi Hiroo, Aizawa Hitoshi
Department of Neurology, Tokyo Medical University.
Rinsho Shinkeigaku. 2018 Jun 27;58(6):403-406. doi: 10.5692/clinicalneurol.cn-001151. Epub 2018 Jun 1.
We report a case of meningeal carcinomatosis that needed to be distinguished from subarachnoid hemorrhage. A 67-year-old female with acute severe headache was admitted to a previous hospital. Since high intensity signal was detected within the parietal cerebral sulci on the right side on brain FLAIR MRI, cerebral angiography was performed due to suspicion of subarachnoid hemorrhage. However, no vascular abnormality was observed. Then, cerebral spinal fluid was collected, which showed an increase in cell count, suggesting meningitis. She was transferred to our hospital for evaluation of neurological disease. After admission to our hospital, there was an episode of hematemesis. Upper gastrointestinal endoscopy was performed, and advanced gastric cancer was found. She was diagnosed as having meningeal carcinomatosis due to gastric cancer. Meningeal carcinomatosis should be considered in addition to subarachnoid hemorrhage when a patient with acute headache shows high intensity signal within the cerebral sulci on brain FLAIR MRI.
我们报告一例需要与蛛网膜下腔出血相鉴别的脑膜癌病病例。一名67岁急性重度头痛女性入住一家医院。由于脑部液体衰减反转恢复序列(FLAIR)磁共振成像(MRI)显示右侧顶叶脑沟内有高强度信号,因怀疑蛛网膜下腔出血而进行了脑血管造影。然而,未观察到血管异常。随后,采集了脑脊液,结果显示细胞计数增加,提示脑膜炎。她被转至我院评估神经系统疾病。入院后,她出现了一次呕血。进行了上消化道内镜检查,发现了进展期胃癌。她被诊断为因胃癌导致的脑膜癌病。当急性头痛患者脑部FLAIR MRI显示脑沟内有高强度信号时,除蛛网膜下腔出血外,还应考虑脑膜癌病。