老年人出血性室管膜瘤.ppt

1、NeurologyTeaching NeuroImage: Hemorrhagic ependymoma in the elderly : A rare cause of headache and gait imbalanceN. Montano, P. De Bonis, F. Doglietto, et al. Neurology 2008;70;e95DOI 10.1212/01.wnl.0000313841.63392.70,神经成像教学：老年人出血性室管膜瘤-头痛和步态不稳的一种罕见原因,Case,A 73-year-old man presented with headaches,

2、 vomiting, and gait imbalance. Neurologic examination demonstrated bilateral papilledema and positive Romberg sign. Neuroimaging showed a posterior fossa lesion with calcifications and intratumoral hemorrhage associated with obstructive hydrocephalus (figure 1, A through D). Gross total resection wa

3、s performed (figure 2, A and B). Histologic examination documented ependymoma (figure 2, C through E).,病例,一名73岁的男子出现头痛，呕吐，步态不稳。神经系统检查显示双侧视神经乳头水肿和Romberg征阳性。神经成像表现后颅窝钙化病变和瘤内出血伴有梗阻性脑积水（图1，A至D）。实行全切术（图2，A和B）。组织学检查证实室管膜瘤（图2，C到E）。,Discussion,Ependymoma typically affects children and rarely occurs in elde

4、rly patients.1 It is most frequently located in the posterior fossa and presents with cerebellar compression and intracranial hypertension. On MRI it appears as a T1-hypointense,T2-hyperintense, homogeneous contrast-enhancing mass that may fill and expand the fourth ventricle;heterogeneous enhanceme

5、nt due to calcifications and cystic components may be seen.2 Intratumoral hemorrhage has been reported and rarely causes an acute presentation.3 Hemorrhagic ependymoma should be considered in the differential diagnosis of hemorrhagic posterior fossa lesions in adults.,讨论,室管膜瘤通常会影响孩子们，很少发生在老年患者。是最常位于

6、后颅窝及显示小脑受压和颅内高压。在核磁共振上表现为T1低信号，T2高信号，均匀的对比度增强团块可能会填补和扩大第四脑室；可以看到由于钙化和囊性内容物产生的异质性增强。瘤内出血被报道很少引起急性表现。应考虑成人出血性室管膜瘤和出血性后颅窝病变的鉴别诊断。,Figure 1 Brain neuroimaging,Nonenhanced CT (A), MRI with axial T2-WI (B), sagittal nonenhanced (C) and enhanced (D) T1-WI, showing a heterogeneous, solid-cystic, hemorrhagic

7、 and calcific mass in the cisterna magna and in the inferior portion of the fourth ventricle. A blood-fluid level is visible in the cystic portion (arrow) and contrast enhancement is evident in the solid intraventricular portion. The mass obstructed the fourth ventricle with resulting hydrocephalus.

8、,图1 脑神经成像,平扫CT（A），MRI轴向T2加权（B），矢状位平扫（C）和增强（D）T1加权小脑延髓池和第四脑室下部呈现异质性，囊实性，出血和钙化团块。在囊性部分可见血液水平（箭头）和室内实心部分对比度明显增强。肿块阻塞第四脑室导致脑积水。,Figure 2 Surgical and histologic image,(A, B) Intraoperative view confirming the hemorrhagic component of the lesion (A) and documenting the floor of the fourth ventricle free

9、of disease at the end of tumor removal (B). (CE) Histologic examination showed monomorphic cells with regular round nucleus and dispersed chromatin;tumor cells of the perivascular area were arranged radially around the vessels, forming perivascular pseudorosettes, with prominent perivascular immunoreaction for glial fibrillary acid protein (D) and epithelial membrane antigen (E). Mitoses and necrosis were absent. Diagnosis: WHO grade II ependymoma.,图2 手术和病理图像,（A，B）术中的观察证实病变的出血