以隱藏式吸入性肺炎表現之腦幹畸胎瘤：病例報告

腦幹腫瘤為一相當少見之疾病，大多數發生在小孩且病理學上大部分屬於膠質細胞瘤(glioma)或腦室內膜瘤(ependymoma)。根據文獻記載, 顱內畸胎瘤(teratoma)大部份好發於蝶鞍上或松果體區(supr-asellar or pineal region)等中線位置, 而發生在腦幹的畸胎瘤，可供查閱之報告迄今僅有一例而已。腦幹腫瘤的臨床症狀可依腫瘤侵犯的位置而有所不同，例如侵犯到橋腦可能發生顏面神經麻痹、單側輕癱或單側聽力喪失；而侵犯到延腦則可能引起厭食、吞嚥困難、上呼吸道感染、嘔吐、聲音沙啞、步態不穩(ataxia)、肢體輕癱、甚至全癱等。本文報告一例以瀰漫性吸入性肺炎為初始表現之22歲女性，不曾發現吞嚥障礙或進食困難，住院期間多次反覆高燒缺氧，甚至呼吸衰竭，血壓下降。在經過積極治療及食道攝影檢查後，才發現所有經口食入之飲食全數跑到氣管及肺部而不自覺，屬於隱藏式吸入。腦部核磁共振造影解釋了這樣的吞嚥問題係由腦幹腫瘤所引起。病患經過了診斷性減壓手術、放射治療、化學治療及吞嚥之復健後，肺炎已痊癒，並可順利經口進食，且生活起居不需依賴他人。

關鍵字

腦幹腫瘤；畸胎瘤；吞嚥障礙；吸入性肺炎；隱藏式吸入

並列摘要

Brain stem tumors are relatively rare but predominantly diseases of childhood. Most of them are astrocytomas or ependymomas histologically. Intracranial teratomas arise in the midline, most comm-only in the pineal and suprasellar regions. Only one documented paper illustrated a teratoma arising in the brain stem. Patients with a brain stem tumor may present different symptoms and signs, such as facial nerve palsy, hemiparesis and unilateral hearing loss when involving the pons; and anorexia, dysphagia, upper respiratory tract infections, vomiting, hoarseness, ataxia and hemiparesis or quadriparesis when involving the medulla oblongata. This case was a 22- year-old female patient who suffered from a diffuse aspiration pneumonia without any symptoms of dysphagia or swallowing difficulties. During admission, she also had sust-ained intermittent high fever, hypoxia and respiratory failure. Silent aspiration was confirmed after the examination of esophagogram, and brain MRI revealed a brain stem tumor located in the medulla oblongata. The patient underwent decompressive craniectomy, adjuvant radiotherapy, chemotherapy and rehabilitation after diagnosis, and finally she has been able to carry on normal activity of daily living without any swallowing difficulty till now.

並列關鍵字

brain stem tumor ； teratoma ； dysphagia ； aspiration pneumonia ； silent aspiration

國際替代計量

以隱藏式吸入性肺炎表現之腦幹畸胎瘤：病例報告

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