脑胶质瘤误诊为急性播散性脑脊髓炎和急性脑梗死原因分析

Analysis of the Causes of Gliomas Misdiagnosed as Acute Disseminated Encephalomyelitis and Acute Cerebral Infarction

目的探讨脑胶质瘤误诊为急性播散性脑脊髓炎和急性脑梗死的原因及防范措施。方法回顾性分析2020年4月—2022年10月收治的病初曾误诊的脑胶质瘤16例的临床资料。结果本组均以突发头痛、头晕及恶心、呕吐就诊,出现感觉和运动障碍、受累肢体乏力10例,表情淡漠9例。头颅MRI检查9例示片状稍长T2、T1信号影,病灶信号均匀;7例示右侧基底节区长T2、等低T1信号影,FLAIR像呈高信号。16例病初误诊为急性播散性脑脊髓炎9例和急性脑梗死7例,予相应治疗效果不佳,误诊时间2~4个月;后均经头颅穿刺病理组织学检查诊断为脑胶质瘤(星形细胞瘤),皆行适形调强技术放疗及同步化疗;随访1年,失访3例,死亡2例,病情稳定11例。结论脑胶质瘤临床表现多种多样,易误诊;临床遇及类似本文患者要注意动态追踪病情,必要时行脑病理组织学检查,以及早明确诊断并治疗。

Objective To investigate the causes and preventive measures of misdiagnosis of glioma as acute disseminated encephalomyelitis(ADEM)and acute cerebral infarction(ACI).Methods The clinical data of 16 cases with initial misdiagnosis of glioma treated from April 2020 to October 2022 were retrospectively analyzed.Results All patients presented with sudden headache,dizziness,nausea and vomiting.There were 10 cases of sensory and motor disturbance,fatigue of the affected limbs,and 9 cases of apathy.Head MRI examination in 9 cases showed slightly longer T2 and T1 signal shadows with uniform signal density of the lesion.Seven cases showed long T2 and equally low T1 signal shadow in the right basal ganglia area,and FLAIR showed high signal.Sixteen cases were initially misdiagnosed as ADEM(n=9)and ACI(n=7).The corresponding treatment was not effective and the duration of misdiagnosis was 2-4 months.All patients were diagnosed with glioma(astrocytoma)by head puncture and histopathology.Nine patients underwent conformal intensity-modulated radiotherapy(IMRT)and concurrent chemotherapy,and 7 patients received only IMRT and concurrent chemotherapy.After 1 year of follow-up,3 cases were lost to follow-up,2 cases died and 11 cases were stable.Conclusion The clinical manifestations of brain glioma are varied,which is,therefore,more likely to be misdiagnosed.For similar patients in clinical settings,attention should be paid to dynamic tracking of the condition,coupled with brain histopathological examination when necessary,for early diagnosis and treatment.