- 期刊
A Metastatic Hepatocellular Carcinoma Manifested as Cerebellar Hemorrhage
轉移性肝細胞癌以小腦出血為初始表現
摘要
小腦出血的原因以高血壓爲主，初始症狀通常是突然急遽頭痛，眩暈及嘔吐。其他原因，包括使用藥物（如抗凝血劑，交感神經刺激劑），動靜脈畸形破裂，以及腫瘤出血等雖有零星病例報告，但案例甚少。腦部轉移性腫瘤多源至肺癌，乳癌，和黑色素瘤，其中約有四分之三轉移到大腦半球，四分之一轉移到小腦。小腦最常見的腫瘤是轉移性腫瘤。肝細胞癌會有64%的肝外轉移，主要以肺部，局部淋巴結及腎上腺爲主。肝細胞癌轉移至腦部，並以小腦出血之病例則非常罕見。本文報告一位52歲男性有B型肝炎帶原病史患者，於六年前在他院門診無意中發現肺部有結節，但未做後續追蹤治療。五年前在接受肝癌篩檢時發現有肝細胞癌而接受肝栓塞及手術治療。後續門診追蹤數年並無肝細胞癌復發的現象。首次於本院住院乃因突然急遽頭痛，眩暈，全身無力，口齒不清，無法走路和嚴重嘔吐送至急診。腦部電腦斷層發現小腦出血，懷疑是高血壓性小腦出血遂施行手術移除血塊，患者情況穩定後，即轉至復健科病房接受復健治療。出院後六個月於神經外科門診追蹤時，因病患再度主訴有頭痛，眩暈及步態更不穩的現象而安排腦部電腦斷層後，才高度懷疑是小腦腫瘤。一週後的腦部磁振造影證實是小腦腫瘤。經腦部手術切除後病理檢查證實爲轉移性肝細胞癌。透過此罕見病例，我們必須謹記小腦出血的各種可能，隨時保持警覺，如果患者合併肝癌病史時，要考慮是否有遠處轉移的可能性。
並列摘要
Spontaneous cerebellar hemorrhage is an uncommon manifestation of metastatic hepatocellular carcinoma (HCC) in the central nervous system. A 52-year-old man with a 45-month history of HCC presented with sudden onset of severe vomiting, headache and difficulty walking. A preliminary diagnosis of hypertensive intracerebellar hemorrhage was made when he was admitted to the intensive care unit. The patient underwent a suboccipital craniotomy to evacuate the intracranial cerebellar hematoma. After a period of treatment, he was discharged from hospital. However, the patient's condition began to worsen six months after the operation. Magnetic resonance imaging of the brain documented a mass in the right hemisphere of the cerebellum. The tumor was radically resected and histology was consistent with metastatic HCC. After one year of regular rehabilitation, the patient could walk with a walker but required supervision and was partially dependent on family members for daily activities.