Kearsley J H, Tattersall M H
Q J Med. 1982 Summer;51(203):279-91.
Sudden neurological deterioration suggesting embolism in a patient with a history of cancer should alert the physician to the possibility of a non-metastatic, and therefore potentially reversible, cause of cerebral embolism before cerebral metastasis is implicated. During a four year period, we have observed eight cases of acute cerebral embolism among 3000 cancer patients seen in a department of medical oncology. Five patients had features post mortem of non-bacterial thrombotic endocarditis, and in one, the diagnosis had been made antemortem, but treatment with heparin did not prevent further emboli. Two patients had radiation related carotid vascular disease, and one patient post lymphangiographic embolism. The literature reporting these uncommon causes of cerebral embolism is reviewed. Post-lymphangiographic embolism carries a uniformly good prognosis. In selected cases of post-irradiation cerebral embolism, surgical intervention may prevent a neurological catastrophe. Non-bacterial thrombotic endocarditis and mucin embolism are of uncertain aetiology and natural history; long-term survival is uncommon, and treatment does not appear to influence the clinical course or outcome.
对于有癌症病史的患者，若突然出现提示栓塞的神经功能恶化，在考虑脑转移之前，医生应警惕存在非转移性、因而可能可逆的脑栓塞病因。在四年时间里，我们在肿瘤内科诊治的3000例癌症患者中观察到8例急性脑栓塞。5例患者尸检有非细菌性血栓性心内膜炎的特征，其中1例生前已确诊，但肝素治疗未能预防进一步的栓塞。2例患者有放疗相关的颈动脉血管疾病，1例患者发生淋巴管造影术后栓塞。本文回顾了报道这些不常见脑栓塞病因的文献。淋巴管造影术后栓塞的预后普遍良好。在某些放疗后脑栓塞病例中，手术干预可能预防神经灾难。非细菌性血栓性心内膜炎和黏液栓塞的病因及自然史尚不确定；长期存活不常见，治疗似乎不影响临床病程或结局。
