酷似脑梗塞的脑胶质细胞瘤

Glioma Mimicking Cerebral Infarction

背景与目的:胶质瘤有时与脑梗塞非常相似,易致临床误诊。本文结合我们遇到的10例,探讨酷似脑梗塞的脑胶质瘤的临床与影像学特点。方法:复习我科1999～2004年间临床初始误诊为脑梗塞后经手术病理检查确诊为脑胶质瘤的10例临床和影像学资料,分析误诊原因,并归纳诊断及鉴别诊断要点。结果:本组患者发病无特异性。CT、MRI都表现为无脑水肿及无明显占位效应的病灶,增强后也无明显强化。临床初始诊断为脑梗塞,经治疗过程中出现疑问而行手术病理证实为胶质瘤。10例都为低级别脑胶质瘤,其中星形细胞瘤WHOI级8例,WHOII级2例。结论:低级别脑胶质瘤可以有不典型的脑梗塞的表现,不易鉴别,易造成误诊,应结合临床表现、病程、实验室检查及影像学特征等多方面进行鉴别诊断。

BACKGROUND ＆ OBJECTIVE： Gliomas some time are not easy to differentiate from cerebral infarction, and misdiagnosis is not uncommon. In this article, learn from our 10 cases, we discuss the atypical clinical characteristics of gliomas and analyze possible causes of misdiagnosis. METHODS： Clinical data and images of 10 patients with gliomas pathologically confirmed, who were treated at our institution from 1999 to 2004, were reviewed retrospectively. RESULTS： There was no particular clinic appearance in all the patients. The lesions on CT and MRI showed no mass effect and brain edema was also not presented. Moreover, the enhancement of the lesion was also absent. However, although primary diagnosis was cerebral infarction, the patients finally received surgery and were pathologically confirmed the diagnosis of glioma. In 10 cases, 8 were astrocytoma WHO grade Ⅰ and 2 were grade Ⅱ. CONCLUSION： Low grade glioma may appear as atypical cerebral infarction, which could resulting in misdiagnosis, and thus, differential diagnosis should be always being in mind.