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目的研究以急性多发脑梗死为首发表现的隐匿性躯体恶性肿瘤患者的临床表现、实验室检查、影像学、微栓子监测检查特点,探讨其可能的发病机制。方法纳入以急性多发性脑梗死为首发表现的隐匿性躯体恶性肿瘤患者12例,收集其临床资料,分析其实验室血液学、头颅MRI、微栓子监测结果及其治疗和预后。结果所有患者均以局灶性神经功能缺损为主要表现,包括偏瘫、失语、偏身感觉障碍、构音障碍、眩晕、肢体抽搐等。头颅DWI示急性多发脑梗死,病灶播散性分布,不符合单支动脉供血区,同时累及双侧前循环或前后循环。11例行D-dimer检查者8例升高。7例行微栓子监测有5例阳性。隐匿性躯体恶性肿瘤包括:肺癌5例,胰腺癌3例,胃癌、结肠癌、子宫内膜癌、转移性低分化粘液腺癌原发肿瘤部位不明各1例;诊断时就已有远处转移者10例。病程中缺血性卒中复发者7例,急性心肌梗死4例,住院期间死亡3例,预后差。结论对于不符合单支动脉供血区的多发急性脑梗死,需要考虑可能合并隐匿性躯体恶性肿瘤,凝血功能筛查高凝状态和微栓子阳性可能是诊断提示线索。
Objective To study the clinical manifestations, laboratory tests, imaging and micro-embolism in patients with occult somatic malignant tumors, which are characterized by acute multiple cerebral infarction. The possible pathogenesis of the study was explored. Methods A total of 12 patients with occult somatic malignant tumor were included in this study. Their clinical data were collected and their laboratory hematology, cranial MRI, microembolic monitoring results and their treatment and prognosis were analyzed. Results All patients had focal neurological deficits as the main manifestations, including hemiplegia, aphasia, hemifacial sensory dysfunction, dysarthria, dizziness, limb twitching and so on. Head DWI showed acute multiple cerebral infarction, disseminated lesions distribution, does not meet the single artery supply area, involving bilateral anterior circulation or before and after the cycle. Eleven patients underwent D-dimer examination in 8 cases. Five of the seven routine microemboli were positive. Occult body malignancies include: 5 cases of lung cancer, 3 cases of pancreatic cancer, gastric cancer, colon cancer, endometrial cancer, metastatic poorly-differentiated mucinous adenocarcinoma of the primary tumor site in each one unknown; distant metastasis has been diagnosed 10 cases. 7 cases of ischemic stroke recurrence in the course of the disease, acute myocardial infarction in 4 cases, 3 died during hospitalization, the prognosis is poor. Conclusions For patients with multiple acute cerebral infarction who do not meet the single artery supply area, it may be clues to diagnosis that may be associated with occult somatic malignancy, hypercoagulable state of coagulation screening and positive of microembolism.