表现为急性双侧前后循环脑梗死的Trousseau综合征的MRI特征
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摘要
目的探讨表现为急性双侧前后循环脑梗死的Trousseau综合征的MRI特征。方法搜集经临床和病理证实的表现为急性双侧前后循环脑梗死的Trousseau综合征6例,对6例患者头部MRI和原发肿瘤CT表现及临床资料进行回顾性分析,并进行相关文献复习。结果 6例患者头部MRI显示双侧大脑、小脑半球皮层、皮层下区和半卵圆中心多发不对称性斑点状、斑片状急性梗死灶,除1例左侧额顶叶大面积楔形急性梗死灶符合大脑中动脉分布外,其余病灶均不符合血管分布。恶性肿瘤分别为胃腺癌2例、胰腺癌1例、肺腺癌1例、宫颈腺癌1例、食管鳞癌1例。结论表现为累及双侧大脑及小脑皮层、皮层下区和半卵圆中心的多发斑点状、斑片状急性前后循环脑梗死及病灶不符合血管分布是恶性肿瘤合并Trousseau综合征的头部MRI较特征性表现,应及早进行肿瘤的筛查和凝血功能的测定,以免病情延误。
Objective To investigate the MRI features of Trousseau's syndrome in which the symptom was acute cerebral infarct with bilateral anterior-posterior circulation involved. Methods We collected the clinical data of 6 cases diagnosed as Trousseau's syndrome in which the symptom was acute cerebral infarct with bilateral anterior-posterior circulation involved. The head MRI,original tumor CT findings and clinical information of the cases were analyzed retrospectively with literature reviewed. Results The 6 cases head MRI showed acute bilateral cerebral infarct with cortical, subcortical cerebral and cerebellum involvement. The lesions were punctate in shape except a large area in left brain. The distribution of the lesions was not consistent with cerebral artery except a large area in left brain. Related malignant tumors were separately gastric carcinoma,pancreatic cancer,lung carcinoma,cervical carcinoma and esophageal carcinoma. Conclusion Acute bilateral anterior-posterior circulation infarct with cortical, subcortical cerebral and cerebellum involvement and the lesion distribution which is not consistent with cerebral artery distribution were head MRI features Of Trousseau's syndrome. Examinations should be performed to search for tumor and investigate clotting function,and reduce delay of the diagnosing the illness.
Objective To investigate the MRI features of Trousseau's syndrome in which the symptom was acute cerebral infarct with bilateral anterior-posterior circulation involved. Methods We collected the clinical data of 6 cases diagnosed as Trousseau's syndrome in which the symptom was acute cerebral infarct with bilateral anterior-posterior circulation involved. The head MRI,original tumor CT findings and clinical information of the cases were analyzed retrospectively with literature reviewed. Results The 6 cases head MRI showed acute bilateral cerebral infarct with cortical, subcortical cerebral and cerebellum involvement. The lesions were punctate in shape except a large area in left brain. The distribution of the lesions was not consistent with cerebral artery except a large area in left brain. Related malignant tumors were separately gastric carcinoma,pancreatic cancer,lung carcinoma,cervical carcinoma and esophageal carcinoma. Conclusion Acute bilateral anterior-posterior circulation infarct with cortical, subcortical cerebral and cerebellum involvement and the lesion distribution which is not consistent with cerebral artery distribution were head MRI features Of Trousseau's syndrome. Examinations should be performed to search for tumor and investigate clotting function,and reduce delay of the diagnosing the illness.
引文
1 Rickles FR,Edwards RL.Activation of blood coagulation in cancer:Trousseau'S syndrome revisited[J].Blood,1983,62:14-31.
2 汪斌超,李龙芸.Trousseau综合征[J].中华内科杂志,2003,42:62-64.
3 Cestafi DM,Weine DM,Panageas KS,et al.Stroke in patients with cancer:incidence and etiology[J].Neurology,2004,62:2025-2030.
4 Kwon HM,Kang BS,Yoon BW.Stroke as the first manifestation of concealed cancer[J].J Neurol Sci,2007,258:80-83.
5 程谦涛,曹向阳.以脑梗死为首发症状的胃癌合并特鲁索综合征一例[J].中华神经科杂志,2014,47:212-213.
6 张华纲,张新宇,樊东升.急性双侧前后循环脑梗死与恶性肿瘤[J].中风与神经疾病杂志,2015,32:627-630.
7 王本孝,王鹏,商利利,等.表现为双侧前后循环脑梗死的Trousseau综合征一例[J].中国神经免疫学和神经病学杂志,2016,23:227-228.
8 Rogers LR.Cerebrovascular complications in cancer patients[J].Neurol Clin N Am,2003,21:167-192.
9 Varki A.Trousseau's syndrome:multiple definitions and multiple mechanisms[J].Blood,2007,110:1723-1729.
2 汪斌超,李龙芸.Trousseau综合征[J].中华内科杂志,2003,42:62-64.
3 Cestafi DM,Weine DM,Panageas KS,et al.Stroke in patients with cancer:incidence and etiology[J].Neurology,2004,62:2025-2030.
4 Kwon HM,Kang BS,Yoon BW.Stroke as the first manifestation of concealed cancer[J].J Neurol Sci,2007,258:80-83.
5 程谦涛,曹向阳.以脑梗死为首发症状的胃癌合并特鲁索综合征一例[J].中华神经科杂志,2014,47:212-213.
6 张华纲,张新宇,樊东升.急性双侧前后循环脑梗死与恶性肿瘤[J].中风与神经疾病杂志,2015,32:627-630.
7 王本孝,王鹏,商利利,等.表现为双侧前后循环脑梗死的Trousseau综合征一例[J].中国神经免疫学和神经病学杂志,2016,23:227-228.
8 Rogers LR.Cerebrovascular complications in cancer patients[J].Neurol Clin N Am,2003,21:167-192.
9 Varki A.Trousseau's syndrome:multiple definitions and multiple mechanisms[J].Blood,2007,110:1723-1729.