摘要
目的 总结肺癌脑转移的临床特点,探讨以脑血管症状为首发表现的肺癌脑转移误诊原因。方法 回顾性分析2019年10月—2022年1月收治的肺癌脑转移9例误诊病例的临床资料。结果 本组9例均因急性头痛,渐进性一侧肢体活动障碍,言语不清、步态不稳,伴有呕吐、轻度意识障碍就诊;均体形消瘦,血压高,单侧肢体无力,肌张力减低。查9例脑脊液压力增高;3例视神经乳头炎。9例行头颅CT检查见均匀高密度影,边界模糊,似有水肿带。初步诊断为脑出血(小量)予降颅压、脱水等对症治疗后效果不佳,转我院后经复查颅脑CT,加行胸部X线、CT检查发现左上肺有团块状影,4例经纤维支气管镜活检、5例经CT引导下经皮肺穿刺活检确诊为左上肺中心型肺癌,确诊为肺癌脑转移。误诊时间9~13 d。9例确诊后予手术切除联合术后放化疗,术后患者一般情况可,术后随访3个月均存活,未复发。结论 肺癌症状多样,以脑血管症状为首发表现的肺癌脑转移患者肺部症状不明显或缺如,缺乏特异性症状体征,易误诊为脑血管意外。加强临床医生对肺癌脑转移的认识,提高警惕性,对以脑血管症状为首发表现且常规治疗效果不佳的中老年患者,应考虑到转移癌的可能,进一步排查原发灶,以降低误诊率。
Objective To summarize the clinical characteristics of lung cancer with brain metastases and to explore the causes of misdiagnosis of lung cancer with brain metastases with cerebrovascular symptoms as the initial manifestation.Methods The clinical data of 9 misdiagnosed cases of lung cancer with brain metastases admitted from October 2019 to January 2022 were retrospectively analyzed.Results In this group,9 patients were treated for acute headache,progressive unilateral limb movement disorder,slurred speech,unsteady gait,vomiting and mild consciousness disturbance.Physical examination showed emaciation,high blood pressure,unilateral limb weakness,and reduced muscle tone.Cerebrospinal fluid pressure increased in 9 patients.There were 3 patients with papillary edema of optic nerve,and routine CT examination of the head of 9 patients showed uniform high-density images with blurred boundaries and edema bands.The initial diagnosis was cerebral hemorrhage(small amount)and symptomatic treatment such as cranial pressure reduction and dehydration was not effective.After being transferred to our hospital,cranial CT re-examination was performed,and chest X-ray and CT examination revealed clumpy shadow in the left upper lung.Four patients were confirmed as central lung cancer in the left upper lung by fiberbronchoscopy biopsy and 5 patients were confirmed as lung cancer with brain metastasis by CT-guided percutaneous lung biopsy.The duration of misdiagnosis was 9-13 d.After diagnosis,9 patients were treated with surgical resection combined with postoperative chemoradiotherapy.The patients were generally in good condition after surgery,and all survived at 3-month follow-up without recurrence.Conclusion The symptoms of lung cancer are varied.The lung symptoms of patients having lung cancer with brain metastases and cerebrovascular symptoms as the initial manifestation are not obvious or absent,and lack specific symptoms and signs,which is,therefore,more likely to be misdiagnosed as cerebrovascular accident.To strengthen the understanding and vigilance of clinicians on lung cancer with brain metastasis,middle-aged and elderly patients with cerebrovascular symptoms as the initial manifestation and poor conventional treatment efficacy,should consider the possibility of metastatic cancer and further screening of the primary lesion should be performed to reduce the misdiagnosis rate.
作者
欧阳葵
梁培日
吴挺国
周经霞
OUYANG Kui;LIANG Peiri;WU Tingguo;ZHOU Jingxia(Department of Geriatrics,Hainan Provincial Geriatrics Hospital,Haikou 571100,China;Department of Neurology,the Second Affiliated Hospital of Hainan Medical College,Haikou 571100,China)
出处
《临床误诊误治》
CAS
2023年第9期1-4,共4页
Clinical Misdiagnosis & Mistherapy
基金
2020年度海南省卫生健康行业科研项目(20A200326)。
关键词
肺肿瘤
脑转移
误诊
脑出血
体层摄影术
螺旋计算机
体层摄影术
X线
穿刺活检
病理学
Lung neoplasms
Brain metastasis
Misdiagnosis
Cerebral hemorrhage
Tomography,spiral computed
Tomography,X-ray
Puncture biopsy
Pathology
