Wang Shengnan, Yang Wenzhuo, Zhu Mingqin, Wang Xiaochuang, Pan Lin, Jin Tao, Chen Youqi, Xi Jianxin, Yang Laiyu, Cui Run
Department of Neurosurgery, Guangdong Second Provincial General Hospital, Guangzhou, China.
Department of Neurology, The First Hospital of Jilin University, Changchun, China.
Front Neurosci. 2023 May 17;17:1174309. doi: 10.3389/fnins.2023.1174309. eCollection 2023.
Leptomeningeal metastasis (LM) has a high degree of malignancy and high mortality. We describe a patient admitted to hospital with acute lower extremity weakness, dysuria, and high intracranial pressure. Enhanced magnetic resonance imaging (MRI) showed extensive enhancement of the leptomeningeal and spinal meninges with multiple nodular changes and extensive fusion. His cerebrospinal fluid (CSF) was yellow and cloudy, the Pandy test was strongly positive (++++), the protein was 46 g/L (normal range 0.15-0.45 g/L), which attracted our attention. Initially, miliary TB with associated tuberculous meningitis (TBM) was diagnosed, and neurosarcoidosis cannot be ruled out. After poor therapeutic effect of standard antituberculosis (anti-TB) therapy, further inspection found that malignant cells were detected by cerebrospinal fluid (CSF) cytology. PET/CT suggested the diagnosis of LM. The purpose of this paper is to describe the characteristics of atypical diffuse LM. In conclusion, when patient with unexplained high levels of CSF protein, it is necessary to be alert to the diagnosis of LM. Multiple examinations of fresh CSF are helpful to increase the positive detection rate of tumor cells. Early diagnosis and active treatment are conducive to improving survival rate.
软脑膜转移（LM）具有高度恶性和高死亡率。我们描述了一名因急性下肢无力、排尿困难和高颅内压入院的患者。增强磁共振成像（MRI）显示软脑膜和脊髓脑膜广泛强化，伴有多个结节样改变和广泛融合。他的脑脊液（CSF）呈黄色且浑浊，潘氏试验强阳性（++++），蛋白为46 g/L（正常范围0.15 - 0.45 g/L），这引起了我们的注意。最初，诊断为粟粒性结核合并结核性脑膜炎（TBM），不能排除神经结节病。在标准抗结核治疗效果不佳后，进一步检查发现脑脊液（CSF）细胞学检测到恶性细胞。PET/CT提示诊断为LM。本文的目的是描述非典型弥漫性LM的特征。总之，当患者脑脊液蛋白水平不明原因升高时，有必要警惕LM的诊断。多次新鲜脑脊液检查有助于提高肿瘤细胞的阳性检出率。早期诊断和积极治疗有利于提高生存率。
