CAJ | 학술논문

目的：探讨伴发神经系统急性症状的恶性淋巴瘤患者的病因、伴随症状、辅助检查及急诊处理。方法总结分析7例确诊为恶性淋巴瘤患者，伴发神经系统症状可逆性急性症状（昏迷、抽搐），分析其发病原因、伴随症状、辅助检查、急诊处理及预后。结果影像学检查5/7例患者未见明显异常，1例患者脑部缺血改变，1例大脑后部白质可疑病变；脑脊液检查5/7例患者蛋白轻度升高，6/7例患者细胞数升高；神经系统可逆性急性症状为昏迷或抽搐；给予对症处理如脱水、止痉、停用可疑药物，其神经系统症状均很快得到控制，但随着基础病的反复，症状再度出现，且病情进展。结论伴发神经系统急性症状如昏迷、抽搐是恶性淋巴瘤患者的不少见的临床急症，及时发现、尽早治疗，对于原发血液病恢复有利，但恶性淋巴瘤伴发神经系统急性症状反复发作提示病情进展或预后不好。
목적：탐토반발신경계통급성증상적악성림파류환자적병인、반수증상、보조검사급급진처리。방법총결분석7례학진위악성림파류환자，반발신경계통증상가역성급성증상（혼미、추휵），분석기발병원인、반수증상、보조검사、급진처리급예후。결과영상학검사5/7례환자미견명현이상，1례환자뇌부결혈개변，1례대뇌후부백질가의병변；뇌척액검사5/7례환자단백경도승고，6/7례환자세포수승고；신경계통가역성급성증상위혼미혹추휵；급여대증처리여탈수、지경、정용가의약물，기신경계통증상균흔쾌득도공제，단수착기출병적반복，증상재도출현，차병정진전。결론반발신경계통급성증상여혼미、추휵시악성림파류환자적불소견적림상급증，급시발현、진조치료，대우원발혈액병회복유리，단악성림파류반발신경계통급성증상반복발작제시병정진전혹예후불호。
Objective To identify and define reversible encephalopathy syndrome companying with malignant lymphoma. The cause, clinical cerebral symptom, examination and treatment were studied. Methods: Seven patients prospectively diagnosed as having reversible encephalopathy syndrome from January 1, 2008 through December 30, 2010, were pooled with retrospectively identified patients admit ed into our department. We performed a detailed review of clinical information, including demographics, presenting symptoms, medical history, and risk factors. Al patients underwent computed tomography of the brain or magnetic resonance imaging and cerebrospinal fluid studies. Results: There were no history of hypertension, autoimmune diseases and sepsis in seven patients studied. It was showed that five patients had normal imaging except one with ischemic cerebrum and another with suspicious posterior leukoencephalopathy by radiological examination. Spinal fluid examination revealed that five patients had high concentration of protein while 6 patients had high cells. Seven of these patients had seizures and temporal coma but these symptoms happened on no prelude. Their neurological symptoms resolved soon after therapies such as dehydration, anticonvulsants were given and dubious medications were stopped. However these encephalopathy syndromes came again with the lymphoma recovering while their state had aggravated. Conclusion: Seizure is the most happening clinical emergency in patients with lymphoma. They must be early found and intervened. Our clinical survey has showed that companying neurological syndromes with lymphoma may indicate its original disease intensified.