以单侧声带麻痹为表现的延髓肿瘤长期误诊致反复肺部感染

目的探讨延髓肿瘤的不典型临床特点,以及单侧声带麻痹并反复肺部感染的可能病因,以减少误诊。方法回顾性分析1例以单侧声带麻痹和反复肺部感染为表现长期误诊的延髓肿瘤的诊治经过。结果该例因声音嘶哑28年,呛咳加重及反复出现肺部感染、肺脓肿7年余就诊。经外院多科室诊治,均以不明原因右侧喉返神经麻痹、肺部感染接受治疗,但无明显改善。在我院经查体、系统专科检查及喉镜检查发现单侧多支脑神经受累症状,行颅底MRI检查发现延髓右侧占位性病变,从而明确声带麻痹病因为延髓肿瘤。结论对于以单侧声带麻痹和反复肺部感染为表现患者,临床医生应拓展诊断思维,考虑到由颅底肿瘤所致的可能。

Recurrent Pulmonary Infection Caused by Long-Term Misdiagnosis of Medulla Tumor Manifesting as Unilateral Vo-cal Cord Paralysis

Objective To study atypical clinical features of the medulla tumor manifesting as unilateral vocal cord paralysis for reducing misdiagnosis and mistreatment of the disease. Methods We retrospectively analyzed the therapeutic process of one case of medulla tumor with long-term misdiagnosis for manifesting as unilateral vocal cord paralysis, which led to recurrent pulmonary infection. Results The patient experienced 28-year history of hoarseness of voice, along with cough, recurrent pulmonary infection and 7-year pulmonary abscess. The patient was treated as right-side recurrent laryngeal nerve paralysis and pulmonary infection in other hospitals, without obvious improvement. Finally, she was admitted to our hospital. After physical and laryngoscope examinations, we fund out symptoms of unilateral multiple cranial nerve involvement. The MRI scanning of skull base found medulla lesion, and we deduced that the clinical manifestation was caused by neural region lesions. Conclusion Clinicians should pay attention to the possibility that unilateral vocal cord paralysis and recurrent pul-monary infection may be caused by skull base tumor.