開放性頭部損傷後に多発性脳神経麻痺で発症し,2年後の脳生検にて中枢神経原発性悪性リンパ腫と診断された1例  [in Japanese] A case of primary central nervous system lymphoma after open head injury  [in Japanese]

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Abstract

症例は66歳男性である.開放性頭部外傷後の抗生剤加療1カ月後より,多発性脳神経麻痺が出現した.Partially treated meningitisによるものと考え,抗生・抗菌剤を投与し症状改善したが,対光反射消失,眼球運動制限,難聴,髄液細胞数増多と糖低下が持続した.6カ月後のMRIで脳幹・頸髄に,ガドリニウム(Gd)で造影される多発性腫瘤病変をみとめ,炎症関連病変と考えた.抗生剤とステロイド剤にて,画像所見は改善したが,臨床症状と髄液異常は持続した.外傷から1年9カ月後にMRIで脳幹部・小脳にGdで造影される多発性腫瘤病変が出現し,生検でびまん性大細胞型B細胞性リンパ腫と診断された.<br>

A 65-year-old man had suffered contusion of the left frontal lobe of the brain with a skull base fracture, pneumocephalus, and cerebrospinal fluid (CSF) leakage. He was treated with ceftriaxone 4 g/day for 14 days, but after 1 month he developed multiple cranial nerve palsies (bilateral III-X). CSF contained increased levels of protein (96 mg/d<i>l</i>) and mononuclear cells (72 cells/mm<sup>3</sup>), and low glucose levels (40 mg/d<i>l</i>, blood sugar 120 mg/d<i>l</i>), but no malignant cells were detected. Magnetic resonance imaging (MRI) disclosed swelling in multiple cranial nerves with Gd enhancement. Anti-biotic and antifungal therapy remitted the facial, glossopharyngeal, and vagus nerve palsies and reduced the Gd-enhancement lesion, as detected by MRI. However, the eyes were bilaterally dilated and medially fixed, and hearing impairments persisted. After 3 months, follow-up MRIs revealed the presence of Gd-enhanced small masses at the ventral pontine base, medulla, and cervicomedullary junctions despite a lack of change in neurological symptoms. Those lesions subsided favorably upon treatment with intravenous and oral corticosteroids. After 1 year and 9 months, Gd-enhanced small cystic masses appeared on the medulla and cerebellum. An open biopsy of the cerebellar tonsillar lesions revealed diffuse large B cell lymphoma. Although the development of primary central nervous system lymphoma after open head injury and infection has not been reported to date, central nervous system lymphomas may mimic diverse neurological diseases. Brain biopsy remains the only definitive diagnosis, and thus should be pursued if blood and CSF markers appear normal.<br>

Journal

  • Rinsho Shinkeigaku

    Rinsho Shinkeigaku 52(5), 329-335, 2012

    Societas Neurologica Japonica

Codes

  • NII Article ID (NAID)
    130004505261
  • NII NACSIS-CAT ID (NCID)
    AN00253207
  • Text Lang
    JPN
  • ISSN
    0009-918X
  • NDL Article ID
    023777929
  • NDL Call No.
    Z19-298
  • Data Source
    NDL  J-STAGE 
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