神经系统副肿瘤综合征的临床特征(附1例报告)

目的探讨神经系统副肿瘤综合征(PNS)的临床特征。方法回顾性分析1例临床表现为头痛的神经系统PNS患者的临床资料。结果本例患者表现为反复头痛发作3年。腰穿CSF检查示细胞数正常,蛋白轻度升高;头颅MRI示双侧丘脑异常信号,增强示双侧丘脑低信号。胸部CT示左肺上叶少许胸膜下肺大泡;PET-CT示左肺上叶(主动脉后方)高代谢结节。肿瘤标志物CA19-9、CA242、癌胚抗原水平升高。病理检查确诊为肺腺癌。本研究回顾性总结PNS相关文献报道,其常见临床表现为眩晕、复视、共济失调、斜视性眼阵挛-肌阵挛及脊髓炎。结论 PNS常见表现为眩晕、复视、共济失调、斜视性眼阵挛-肌阵挛及脊髓炎,以反复头痛为临床表现少见,可疑患者应行全身检查排除PNS。

Clinical features of paraneoplastic syndrome of nervous system (report of a case)

Objective To investigate the clinical features of paraneoplastic syndrome of nervous system(PNS). Methods The clinical data of a patient with PNS presenting as headache was retrospectively analyzed. Results The patient presented with recurrent headache attacks for 3 years. Lumbar puncture CSF examination showed normal cell count and slight increase in protein. Cranial MRI showed bilateral thalamic abnormal signals and enhanced bilateral thalamic low signals. Chest CT showed a few subpleural pulmonary bullae in the upper lobe of the left lung. PET-CT showed hypermetabolic nodules in the upper lobe of the left lung(posterior to aorta). The levels of tumor markers CA19-9, CA242 and carcinoembryonic antigen were increased. Pathological examination confirmed lung adenocarcinoma. This study retrospectively summarizes the relevant literature reports on PNS. Its common clinical manifestations were vertigo, diplopia, ataxia, opsoclonus-myoclonus and myelitis. Conclusions The common manifestations of PNS are vertigo, diplopia, ataxia, opsoclonus-myoclonus and myelitis. Recurrent headache is rare in clinical manifestations. Suspected patients should undergo systemic examination to exclude PNS.