Metastatic brain tumors misdiagnosed cerebral hemorrhage, 1 case of cervical spondylosis_20770

By Tyler Hudson,2014-11-02 09:47
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Metastatic brain tumors misdiagnosed cerebral hemorrhage, 1 case of cervical spondylosis_20770

    Metastatic brain tumors misdiagnosed cerebral hemorrhage, 1 case of cervical spondylosis




     [Keywords:] brain metastases, brain hemorrhage, cervical spondylosis

     1 Case information

     Patients, male, 61 years old. Because of headache,

    dizziness, numbness of the right limbs with 1 month hospitalization. Nearly a month with no clear trigger severe headache, flu like burst, and pain to the left, with visual material Rotate , nausea, vomiting, vomit, the stomach contents, non-jet-like. no diplopia, no limb movement

    disorder, dizziness, increased activity in head and neck, the right limb numbness, pain. was outside the hospital, the degree of headache The reduced, sustained pain, tolerable, but still dizzy activities can not be freely transferred into our

    hospital. A few years ago had a history of head injury, was not unconscious, vomiting. Physical examination: BP150/84mmHg clear consciousness, left pupil diameter of 2.5mm on the right side of the pupil diameter 1.5mm, light reflex sensitivity,

    binocular horizontal nystagmus (-, neck resistance, limb

    muscle strength, muscle tone normal, refer to nose test was negative, with the knee-shin test was negative, eyes closed

    standing sign (+, pathological sign was not elicited. auxiliary examination: blood: WBC 4.1 ?? 109 / L, N 50.2%, RBC 3.52 ?? 1012 / L, PLT 46 ?? 109 / L. chest X-ray report:

    transparency decreased right upper lung. skull CT: cerebral hemorrhage in the left occipital lobe. cervical spine films: C5 ~ 6 vertebral bone sharpened trailing edge.

     Admission diagnosis: (1 cerebral hemorrhage, (2 cervical disease. Treatment after: to reduce intracranial pressure, nutrition, symptomatic treatment of brain cells. The first 2 days in patients with head pain is more obvious appeal, head

    and neck activity, dizziness, vomiting, worsening cerebral hemorrhage considered course of the disease has more than 20 days have passed the peak of brain edema, the use of low

    intracranial pressure caused by dehydration headache, so disable mannitol plus nimodipine prevention of cerebral

    vasospasm. lumbar puncture, cerebrospinal fluid drops 95 drops / min , cerebrospinal fluid and transparent, colorless, non-

    condensable, Pan's test was weakly positive, WBC 5 ?? 106 / L, GLU 3.33mmol / L, Cl-113mmol / L, protein 0.4g / L, thin film

    test was negative. cranial MRI examination revealed: left occipital lobe, right cerebellar hemisphere are visible flakes of irregular points, blocks abnormal signal lesions. consider: (1 brain metastases may be; (2 obstructive hydrocephalus.

    tumor serum markers check: AFP, TPSA, FER normal , CEA 145.38??g / L (0 ~ 5, CA19-9 51.37ku / L (0 ~ 37, CA125

    313.4ku / L (0 ~ 35. Fixed diagnosis: brain metastases. the treatment of increased intracranial pressure reduced the amount of dehydration, symptoms associated with hormone significantly improved. suggested lung CT, gastroscopy and so further examination, the patient refused, the hospital discharged after 12 days.

     2 Discussion

     Brain metastases (brain metastases Liu, also known as the

    primary means other parts of the body of tumor cells into the brain, the incidence rate of 3.5% of intracranial tumors accounted for 10%, both at home and abroad that the most common lung cancer with brain metastasis , followed by melanoma, genitourinary cancer and gastrointestinal tumors, is also a considerable part of patients can not find the primary tumor, brain metastasis even if surgery can not be determined after the tumor source. the peak age of onset 40 to 60 years old, male than women. misdiagnosis in this case: (1 thinking

    narrow cervical disease, cerebral hemorrhage is more common in clinical practice, and brain metastases are relatively rare, the patient was elderly, abnormal cervical film tips, easy one-sided consideration of cervical disease - vertebrobasilar

    artery insufficiency. (2 dizziness, standing firm, numbness is the vertebral basilar insufficiency and the common signs of brain metastases, when the clinical manifestations of the lack of muscle strength, muscle tone changes, language barriers,

    papilledema and seizures of When signs of economic disorders, clinicians only consider the common disease. (3 over-reliance

    on CT findings, CT low resolution, artifacts and more. (4 pupil found to have bilateral ranging from large, conventional

    fundus examination without making . (5 lack of clinical manifestations of primary tumors. In this project of dizziness

    in elderly patients with vertebrobasilar insufficiency considering the same time, we should be, except dizziness caused by other disorders, even in the absence of symptoms of other diseases common cases, suspected cerebellar lesions, recurrent symptoms after treatment is not easy remission of brain MRI examination in time for early diagnosis.

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