Obeid Dana A, Alhujayri Abdulaziz K, Aldekhayel Salah
College of Medicine, King Saud bin Abdulaziz University for Health Sciences Riyadh, Saudi Arabia.
King Abdullah International Medical Research Center Riyadh, Saudi Arabia.
Int J Burns Trauma. 2018 Dec 20;8(6):145-148. eCollection 2018.
Mortality in major burns is caused mainly by multisystem organ failure. Brain lesions in burn patients are rare and predominantly traumatic in nature. Here, we present an unusual case of burn-induced glioma causing rapid neurological deterioration and death.
A 33-year-old male, with 85% total body surface area (TBSA) flame burns, presented initially with inhalation injury and acute compartment syndrome with no other associated injuries. Based on the initial assessment, the patient's cognitive status was not affected, with a Glasgow coma scale (GCS) on admission of 15/15 and normal brain computed tomography (CT) images. The patient was resuscitated and immediately admitted to the burns unit where he underwent multiple sessions of debridement and skin grafting. The patient's neurological status deteriorated dramatically, and brain magnetic resonance imaging (MRI) confirmed the presence of a heterogenous mass, highly suggestive of a high-grade glioma, that was not present during the initial assessment. Unfortunately, the patient died shortly afterwards as a result of cardiac asystole.
Multiple studies have demonstrated a connection between chronic inflammatory processes and gliomagenesis. The case presented here supports the notion that high-grade gliomas can progress rapidly in immunocompromised patients, thus further reducing survival rates. Therefore, patients with inflammatory conditions combined with neurological symptoms/signs should be investigated thoroughly to evaluate the presence and extent of such pathology. Newly developed radiological modalities can help in early detection and timely management of the condition.
大面积烧伤患者的死亡主要由多系统器官功能衰竭引起。烧伤患者的脑损伤较为罕见，主要为创伤性损伤。在此，我们报告一例罕见的烧伤诱发胶质瘤病例，该病例导致患者迅速出现神经功能恶化并死亡。
一名33岁男性，全身85%体表面积遭受火焰烧伤，最初表现为吸入性损伤和急性骨筋膜室综合征，无其他相关损伤。根据初始评估，患者的认知状态未受影响，入院时格拉斯哥昏迷量表（GCS）评分为15/15，脑部计算机断层扫描（CT）图像正常。患者接受了复苏治疗，并立即被收入烧伤科，在那里接受了多次清创和皮肤移植手术。患者的神经状态急剧恶化，脑部磁共振成像（MRI）证实存在一个异质性肿块，高度提示为高级别胶质瘤，而在初始评估时并未发现。不幸的是，患者随后因心搏骤停死亡。
多项研究表明慢性炎症过程与胶质瘤发生之间存在关联。本文报告的病例支持这样一种观点，即高级别胶质瘤在免疫功能低下的患者中可能进展迅速，从而进一步降低生存率。因此，对于患有炎症性疾病并伴有神经症状/体征的患者，应进行全面检查以评估此类病变的存在及范围。新开发的放射学检查方法有助于早期发现并及时处理该疾病。
