多发性硬化与多发性脑转移瘤的鉴别

 目的　探讨多发性硬化（MS）与多发性脑转移瘤的鉴别要点。方法　选择1例曾被误诊为多发性脑转移瘤且做了手术的MS病例，分析其误诊原因。结果　误诊原因为忽视了病史的重要性；对 MS早期表现缺乏认识；对MS的非脱髓鞘病变认识不足；对MS和多发性脑转移瘤在头颅MRI上的不同表现注意的不够全面；过分重视影像学检查，未将影像学的表现与临床情况结合起来分析；忽略了脑脊液常规检查项目。结论　临床遇到多发性脑转移瘤应想到与MS的鉴别。对难以鉴别的病例要深入检查,切忌贸然进行手术或放疗。

Differential diagnosis of multiple sclerosis and multiple metastatic encephaloma

Objective　To investigate the diagnostic points of multiple sclerosis and multiple metastatic encephaloma. Methods　Choose a case of multiple sclerosis, which had been misdiagnosed as multiple metastatic encephaloma and operated on, to analyse its reasons of misdiagnosis. Results　Reasons for the misdiagnosis: The neglect of the importance of the disease history. The scant knowledge of the early represen－tations of the atypical MS (demyelinating pseudotumor). The lack of the knowledge of the non-demyelinating lesions of the MS. The lack of attention to the different representations of the MRI scan between the acute MS and the multiple metastatic encephaloma. The excessive importance is attached to the imageological report. The neglect of the routine examination of cerebrospinal fluid. Conclusion　When multiple metastatic en－cephaloma develops, the differential diagnosis of MS should be made. The further examinations should be done to those cases which are hard to tell the difference with metastatic encephaloma by clinical and imageo－logical representations. Try to avoid undergoing surgery or radiotherapy hastily.