- 期刊
Unexpected Finding of Early Onset of Meningioma-Induced Parkinsonism Detected by ^(99m)Tc-TRODAT-1 Scintigraphy
使用Trodat-1造影卻意外發現年輕病人因腦膜瘤引發的巴金森氏症
摘要
A 36-year-old young presented with gait disturbance with right foot weakness and right-hand tightness sensation for 6 months. Symptoms were not relieved by muscle relaxants and even deteriorated into apraxia within few weeks. ^(99m)Tc-TRODAT-1 dopamine transporter scan with SPECT was prescribed for parkinsonism survey. Homogenous normal uptake over bilateral striatum was noted. However, an unexpected radioactivity lesion over left superior sagittal area was found. MRI revealed a giant mass (5.3 × 5.3 × 5.0 cm) over left frontal parasagittal region with more than 1 cm midline shifted. Dura tail was visible and heterogenous signal intensity was shown in T2-weighted images [1]. Signal enhancement was noted over tumor in T1-weighted image with gadolinium contrast. Surgical resection was performed and pathological proved as meningioma. After the operation, the patient's symptom improved. Even though parkinsonism in a patient with intracranial meningioma is rare [2,3]; however, the most common type of CNS tumor reported to cause parkinsonism is meningioma [4,5]. This is an early onset case for secondary tumoral parkinsonism with large tumor size (> 100 mL) and our case presents well-distribution of radiopharmaceutical in caudate and putamen with movement disorder.
並列摘要
36歲女性出現步態不穩，伴隨右邊肢體緊繃與無力。經過肌肉鬆弛劑治療之下沒有改善，反而更加惡化，引發肢體動作失用症。臨床上懷疑巴金森氏症，經由^(99m)Tc-TRODAT-1造影之下發現雙側紋狀體吸收對稱且正常，但卻在左側上矢狀竇發現異常吸收。藉由MRI造影之下發現巨大的腫瘤（5.3×5.3×5.0 cm）位於左額葉接近矢狀竇的區域有一顆腫瘤，並有中線位移。腦膜尾在T2加權影像上非常明顯。腫瘤在顯影劑的造影之下，T1加權影像訊號增強。手術切下之後病理報告顯示為腦膜瘤。手術之後，病人症狀顯著改善。既使腦膜瘤導致巴金森氏症的案例少見，但卻是最常見的腫瘤導致巴金森氏症。這位年輕的病人，因巨大的腦膜瘤（大小超過100 mL）引發的次級巴金森氏症，藉由^(99m)Tc-TRODAT-1意外而發現。