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目的 多发性硬化 ( MS)以占位病变为临床表现时 ,临床及影像学均难以与肿瘤相鉴别 ,本文旨在通过病例报道及相关文献复习 ,分析其临床特征 ,提高对此类病变的认识。方法 报告 3例经病理证实的以占位病变为首发症状的 MS病例。结果 MS以占位病变为临床表现时 ,最易被误诊为神经胶质瘤 ,病变部位以额顶叶为多 ,约半数在疾病较早期或病程中出现头痛、恶心等颅内高压征 ,MS与肿瘤的误诊易发生在急性期。结论 对已怀疑或诊断为 MS的患者 ,临床表现和影像学提示占位者 ,应考虑脱髓鞘性假瘤的可能 ,可试用激素 ,定期复查。对于首次发病即表现为占位征象 ,影像学亦支持者 ,应密切结合诱发电位、MRI、免疫学检查以及定期随访 ,必要时行活组织检查 ,以明确诊断 ,除外 MS。
Objective Multiple sclerosis (MS) to occupy the lesion as a clinical manifestation, clinical and imaging are difficult to differentiate from the tumor, this article aims to review and analyze the case reports and related literatures, to improve their understanding of such lesions . Methods Three cases of pathologically confirmed MS with occupying lesions as the first symptom were reported. Results MS was the most likely to be misdiagnosed as glioma when occupying the lesion. Most of the lesion sites were prefrontal lobe, about half of them had headache and nausea and other intracranial hypertension in the early stage of the disease or MS. MS Misdiagnosis with the tumor prone to occur in the acute phase. Conclusion For patients suspected or diagnosed as MS, the clinical manifestations and imaging tips should consider the possibility of demyelinating pseudotumor, hormone can be tested, regular review. For the first time that is manifested as a symptom of occupying the first appearance, imaging supporters should be closely combined with evoked potential, MRI, immunological examination and regular follow-up, if necessary, biopsy to confirm the diagnosis, with the exception of MS.