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目的分析以脑梗死为首发表现的转移性脑肿瘤的临床特点,为避免误诊提供参考。方法回顾分析34例此类转移性脑肿瘤的临床表现和辅助检查等资料,探讨其与脑梗死的鉴别要点。结果34例中有原发肿瘤25例,不明病灶9例;9例行手术治疗,6例行化疗,2例行放疗,17例保守处理后自动出院;均于发病后1～7月死亡。本组转移性脑肿瘤有以下特点:(1)起病较急,均以脑部症状发病,无原发病灶表现;(2)头颅CT呈单发病灶,好发于皮层与白质交界处,水肿占位效应不明显;(3)患者肢体瘫痪程度较轻,肌力Ⅲ～Ⅳ~-级;(4)早期脱水治疗有效;(5)1～2周后病情逐渐加重,预后差。结论脑转移性肿瘤与脑梗死各具有一些特征,鉴别需综合分析,以免误诊误治。
Objective To analyze the clinical features of metastatic brain tumors with cerebral infarction as the first manifestation, to provide reference for avoiding misdiagnosis. Methods Retrospective analysis of 34 cases of such metastatic brain tumors clinical manifestations and laboratory tests and other data to explore the main points of identification with cerebral infarction. Results Of the 34 cases, there were 25 primary tumors and 9 unidentified ones. Surgical treatment was performed in 9 cases, chemotherapy was performed in 6 cases, radiotherapy was performed in 2 cases, and spontaneous discharge was performed in 17 cases after conservative treatment. Both of them were died from January to July after onset. This group of metastatic brain tumors have the following characteristics: (1) more acute onset, are symptoms of brain disease, no primary lesion performance; (2) head CT was single lesions occur in the cortex and white matter junction, Edema volume effect is not obvious; (3) the patient’s limb paralysis lighter, muscle strength Ⅲ ~ Ⅳ ~ - grade; (4) early dehydration therapy; (5) 1-2 weeks later the condition gradually aggravated, the prognosis is poor. Conclusion Brain metastatic tumors and cerebral infarction have some characteristics of each, the need for a comprehensive analysis to avoid misdiagnosis and mistreatment.