Fadul C, Misulis K E, Wiley R G
J Clin Oncol. 1987 Jul;5(7):1107-15. doi: 10.1200/JCO.1987.5.7.1107.
Prompted by several unsatisfactory outcomes, we reviewed the records of 59 patients with cerebellar metastases (26 solitary) with respect to clinical presentation, diagnosis, and natural history. Eighty-seven percent of patients initially complained of headache, gait disturbance, and/or dizziness. At time of diagnosis, 92% of patients with solitary cerebellar metastases and 74% of the overall series complained of headache and/or difficulty walking. In three of four cases, magnetic resonance imaging (MRI) was superior to x-ray computed tomography (CT) in detecting the cerebellar lesions. Several patients acutely deteriorated during evaluation or at the initiation of radiation therapy. We conclude that a cancer patient presenting with headache and gait difficulty with or without nausea/vomiting and dizziness should promptly undergo head CT scanning, and that MRI is useful even if CT is negative. In addition, we recommend that patients with documented cerebellar metastases receive high-dose glucocorticoid therapy for 48 to 72 hours before beginning radiation therapy. The presence of symptomatic hydrocephalus or failure to respond to glucocorticoids initially are particularly ominous features that may be best managed by early neurosurgical consultation before beginning radiation therapy.
鉴于一些不尽人意的结果，我们回顾了59例小脑转移瘤患者（26例为孤立性）的临床症状、诊断及自然病史。87%的患者最初主诉头痛、步态障碍和/或头晕。在诊断时，92%的孤立性小脑转移瘤患者及74%的全部病例主诉头痛和/或行走困难。四分之三的病例中，磁共振成像（MRI）在检测小脑病变方面优于X线计算机断层扫描（CT）。部分患者在评估期间或放疗开始时病情急剧恶化。我们得出结论，出现头痛及步态困难，伴或不伴有恶心/呕吐及头晕的癌症患者应立即进行头部CT扫描，即便CT结果为阴性，MRI检查也很有用。此外，我们建议有记录的小脑转移瘤患者在开始放疗前接受48至72小时的大剂量糖皮质激素治疗。出现症状性脑积水或最初对糖皮质激素无反应是特别不祥的特征，在开始放疗前，最好通过早期神经外科会诊进行处理。
