药物过度使用性头痛患者漏诊脑膜转移癌一例

Missed diagnosis of leptomeningeal metastasis in a woman with medication-overuse headache:one case report

脑膜转移癌又称癌性脑膜炎、脑膜癌病,是恶性肿瘤晚期严重的并发症之一,临床上容易被漏诊及误诊。该文报道1例52岁女性患者,其因"反复头痛30余年,加重1年"入院,既往有慢性偏头痛病史,长期口服止痛药物治疗,头痛反复发作并逐渐加重。眼底检查提示双侧视乳头水肿伴出血,头颅MRI显示交通性脑积水、脑膜线性强化,脑脊液压力明显增高,脑脊液细胞学发现异型肿瘤细胞,胸部CT提示周围型肺癌,正电子发射计算机断层显像显示肺癌全身广泛转移,为肺癌晚期阶段,已无手术指征。出院后随访,患者自服"吗啡缓释片、地西泮片、利尿剂"等药物治疗,病情逐渐加重,呼吸困难,全身不能活动,终日卧床。

Leptomeningeal metastasis, also known as cancerous meningitis and meningeal carcinoma, is one of the most severe complications of the advanced-stage malignant tumors.It is likely to be missed diagnosis and misdiagnosed in clinical settings.In this article, we reported one female patient aged 52 years admitted due to recurrent migraine for over 30 years which aggravated for 1 year.She had a medical history of chronic migraine and was orally administered with analgesics drugs for a long period of time.She suffered from recurrent headache and gradually aggravated.Fundus examination prompted bilateral optic disk edema complicated with hemorrhage.Head MRI revealed communicating hydrocephalus, leptomeningeal enhancement and significant elevation of intracranial pressure.Cytological examination of the cerebrospinal fluid detected malignant cells.Chest CT scan hinted peripheral lung cancer.PET-CT revealed the systemic metastasis of advanced-stage lung cancer.There was no surgical indications.During subsequent follow-up after hospital discharge, she was administered with morphine slow release tablet, diazepam and diuretic, whereas the severity of disease was gradually aggravated.She suffered from dyspnea and had to lie in bed and failed to do physical activity.