上消化道出血合并截瘫一例

1 病例资料 患者女性,65岁.主因"黑便1 d、呕血 2 h"于2006年12月20日入北京大学第三医院.患者1 d前无明显诱因排黑便1次,量约400 mL,2 h来呕鲜血2次,总量约500 mL,伴头晕、心悸、中上腹不适,无腹痛、晕厥、胸痛等不适.既往史:高血压、冠心病、糖尿病及肾功能不全,近期服用阿司匹林.否认肝病史.入院查体:血压153/93 mm Hg(1 mm Hg=0.133 kPa),脉搏80次/min,外周淋巴结未触及,贫血貌,巩膜无黄染,结膜苍白,双肺呼吸音清,心率80次/min,律齐,未闻及杂音.腹软,剑下压痛,无反跳痛、肌紧张,肝脾未触及,肠鸣音2～3次/min.

A case of upper gastrointestinal bleeding and paraplegia

SUMMARY Lymphoma is a systemic disease. It is not uncommon to be found involved in digestive or central nervous system. However, lymphoma involved in these two systems at the same time is rare. The clinical feature of a case of lymphoma with gastrointestinal bleeding and limbs weakness was investigated and the literature was reviewed. The patient came to our hospital with melena and hematemesis. She was diagnosed as gastric ulcer by gastroscopy and biopsy showed lymphoma. Two days after she came to hospital, the patient presented with progressing limbs weakness. Magnetic resonance imaging (MRI) showed irregular abnormal signals in T2-T4 vertebra, which was enhanced obviously. A strip abnormal signal could be seen in spinal cord and involved in neighboring centrum and ribbing. The lesion extended to paravertebral tissue. The final diagnosis was lymphoma involved in stomach and spinal cord. Diseases presented with both upper digestive tract bleeding and symptoms of central nervous system were rare, including malignancies, virus infection and some therapy. Lymphoma was one of the causes. On the other hand, spinal cord ischemia might occur after gastrointestinal bleeding. Thus, doctors should examine the patients carefully to diagnose these diseases.