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目的探讨以急性脑梗死为首发表现躯体恶性肿瘤的临床特点及发病机制。方法收集分析32例因急性脑梗死入院,住院期间证实患非颅内恶性肿瘤患者的临床资料。结果 32例患者中男23例,女9例,平均年龄(47.1±3.2)岁。32例患者均急性起病,发病前均无躯体疼痛,主要症状为局灶神经功能缺损。11例患者有一种或多种脑卒中危险因素。偏瘫14例,失语7例,其他包括偏身感觉障碍、偏盲、复视、眩晕、构音障碍、单眼黑朦等。外周血D-二聚体增高20例,CA-l25增高22例,CA-l99增高24例。弥散加权成像(DWI)均累及多支动脉供血区,20例累及双侧前循环和后循环,12例累及双侧前循环。病灶累及小脑半球2例,大脑半球脑叶皮层下14例;大脑半球深部7例,基底节、丘脑、内囊各2例,脑干3例。心脏彩超均无发现异常,CT血管造影(CTA)及磁共振血管成像(MRA)显示7例颅内血管狭窄或闭塞,27例头部DWI出现2个以上同一颅内不同动脉供血区的分散小病灶。肿瘤类型按部位,肺癌最多见,按病理类型分腺癌多见。恶性肿瘤确诊时间多为脑梗死发生后3~14 d,确诊时14例已发远处转移。脑梗死后30 d,预后良好12例,预后不良19例,死亡1例。结论以急性脑梗死为首发表现的恶性肿瘤患者常缺乏传统脑卒中危险因素,其外周血D-二聚体和肿瘤抗原水平升高、脑内多发性脑梗死灶、血液高凝状态均与脑梗死的发病有关。静脉溶栓治疗恶性肿瘤并发脑梗死的安全性尚待研究,临床目前偏向于接受重组织型纤维蛋白溶酶原激活物静脉溶栓治疗更安全有效。
Objective To investigate the clinical features and pathogenesis of somatic malignant tumors with acute cerebral infarction as the first manifestation. Methods The clinical data of 32 patients admitted to hospital due to acute cerebral infarction and confirmed to be non-intracranial malignant tumors during hospitalization were collected and analyzed. Results Among the 32 patients, 23 were male and 9 were female, with an average age of 47.1 ± 3.2 years. 32 patients were acute onset, no physical pain before onset, the main symptoms of focal neurological deficit. Eleven patients had one or more stroke risk factors. Hemiplegia in 14 cases, aphasia in 7 cases, others include partial sensory dysfunction, hemianopia, diplopia, dizziness, dysarthria, monocular blackness and so on. Peripheral blood D-dimer increased in 20 cases, CA-l25 increased in 22 cases, CA-l99 increased in 24 cases. Diffusion-weighted imaging (DWI) involved multiple arterial donor areas, with 20 involving bilateral anterior circulation and posterior circulation and 12 with bilateral anterior circulation. Lesions involved cerebellar hemispheres in 2 cases, cerebral hemispheres in 14 cases of cerebral cortex; deep brain hemisphere in 7 cases, basal ganglia, thalamus, internal capsule in 2 cases, 3 cases of brain stem. Seven cases of intracranial stenosis or occlusion were found in CT angiography (CTA) and magnetic resonance angiography (MRA). There were more than two DWI in 27 cases with scattered small intracranial different arterial blood supply areas Lesions. Tumor types according to location, the most common lung cancer, according to the pathological type of sub-adenocarcinoma more common. Malignant tumor diagnosed more than 3 to 14 days after the onset of cerebral infarction, 14 cases confirmed the distant metastasis. Thirty days after cerebral infarction, the prognosis was good in 12 cases, with a poor prognosis in 19 cases and 1 death. Conclusions Malignant tumors, with acute cerebral infarction as the first manifestation, often lack traditional risk factors of stroke, with elevated levels of D-dimer and tumor antigens in peripheral blood. Cerebral multiple cerebral infarction and blood hypercoagulability are associated with brain The incidence of infarction. The safety of intravenous thrombolysis in the treatment of malignant tumors associated with cerebral infarction remains to be studied. The current clinical practice is that it is safer and more effective to receive intravenous thrombolytic therapy of recombinant tissue plasminogen activator.