CAJ | 학술논문

目的：探讨不典型脑干海绵状血管瘤误诊为胶质瘤的临床表现及影像学特征。方法回顾性分析1例经手术及病理学证实为脑干海绵状血管瘤患者的临床及影像学资料，并文献复习。结果患者临床首先表现左侧肢体乏力、头痛，自觉左侧肢体稍乏力，左侧脚大拇指屈曲困难，颅脑磁共振（ MRI）平扫显示脑干囊性病变，增强扫描显示病灶呈环形强化，壁稍厚，环形稍模糊。 MRI波谱分析，显示N?乙酰天门冬氨酸峰值减低，胆碱峰值升高，考虑诊断为胶质瘤。进行放射治疗，于模拟机下定位，行局部放射治疗，连续治疗15次，同时予以替莫唑胺化疗，疗程结束后肢体乏力及头痛症状未见明显减轻，并且症状加重，出院时患者生活不能自理。病程持续近1年，临床主要症状为头痛，术后病理为脑干海绵状血管瘤。结论脑干海绵状血管瘤可以呈囊性改变，增强扫描时可以呈环形强化，需要与脑干胶质瘤鉴别诊断。
목적：탐토불전형뇌간해면상혈관류오진위효질류적림상표현급영상학특정。방법회고성분석1례경수술급병이학증실위뇌간해면상혈관류환자적림상급영상학자료，병문헌복습。결과환자림상수선표현좌측지체핍력、두통，자각좌측지체초핍력，좌측각대무지굴곡곤난，로뇌자공진（ MRI）평소현시뇌간낭성병변，증강소묘현시병조정배형강화，벽초후，배형초모호。 MRI파보분석，현시N?을선천문동안산봉치감저，담감봉치승고，고필진단위효질류。진행방사치료，우모의궤하정위，행국부방사치료，련속치료15차，동시여이체막서알화료，료정결속후지체핍력급두통증상미견명현감경，병차증상가중，출원시환자생활불능자리。병정지속근1년，림상주요증상위두통，술후병리위뇌간해면상혈관류。결론뇌간해면상혈관류가이정낭성개변，증강소묘시가이정배형강화，수요여뇌간효질류감별진단。
Objective To discussion clinical manifestation and the imaging characteristics of atypical brain stem cavernosum malformation. Methods The clinical and imaging data of one patient with brain stem cavernous malformation who was confirmed by pathology were analyzed, and related literatures were reviewed.Results Left limb weakness,headache were the first symptoms.The patient felt the left side of the body was slightly weak and the left foot thumb flexion was difficult. Brain magnetic resonance imaging ( MRI) scan showed:the brain has cystic lesions;MRI enhanced scan showed that the lesions assumed ring enhanced,slightly thick wall,slightly blurred ring.MRI spectrum analysis showed that NAA peak increased, CHO peak decreased, which was considered glioma. Under the simulator positioning local radiotherapy was given for 15 times in a row. Temozolomide chemotherapy was given at the same time. Limb weakness and headache symptoms were not significantly reduced after treatment,while symptoms aggravated,and the patient could not take care of himself when discharged from the hospital.The course lasted nearly 1 year,the main clinical symptom was headache,postoperative pathology was brain stem cavernous.Conclusions Through the analysis of the case, brain stem cavernous malformation can show cystic change, and can be showed ring enhancement in enhanced scan.It should distinguish from brain stem glioma.