以腕隧道症候群爲初始臨床表現之腦部神經膠母細胞瘤：病例報告

Carpal Tunnel Syndrome as an Initial Presentation of Glioblastoma Multiforme: A Case Report

曾智宏(Chih-Hung Tseng) ； 吳坤霖(Kun-Lin Wu) ； 何昕豪(Sin-Hao Ho) ； 蔡素如(Su-Ju Tsai)

《台灣復健醫學雜誌》 38卷3期 (2010/09) Pp. 181-187

https://doi.org/10.6315/2010.38(3)06

摘要

神經膠母細胞瘤(glioblastoma)是成人最常見、也是最惡性的原發性顱內腫瘤，發生率約每年每十萬人3至4人。此疾病的預後不佳，即使以手術、放射線治療及化學藥物的合併治療方式，平均存活時間僅約十二至十五個月。患者常因神經功能的受損、腫瘤導致的全身性影響，以及治療時產生的副作用，造成身體、社交、職業及情緒上的障礙，也增加家庭及社會照顧的負擔。
本文報告一位四十三歲女性病人，最初始的臨床症狀爲右手拇指及食指有間歇性麻木刺痛，症狀逐漸加重，變成手指整天持續麻木刺痛，此時的臨床表現與相關理學檢查，均類似腕隧道症候群。因此她接受腕隧道減壓手術治療，但症狀並未改善。隨著症狀惡化，陸續出現右側肢體與臉部麻木、行走不穩等神經學病徵，才發現腦部腫瘤，經手術與組織切片，確診爲神經膠母細胞瘤。患者後續接受化療藥物合併放射線治療，以控制疾病進展，並經由復健訓練使得行走與生活自理能力獲得大幅改善。此外，本文亦同時探討腦瘤患者復健期間的身心問題。
藉由此病例提醒臨床醫療工作者，腦部腫瘤臨床表現是多變的，唯有仔細且完整的評估，才能早期發現，正確處置。對於如神經膠母細胞瘤般惡性的腦瘤病人，隨著治療的進展與生命的延長，適時有效的復健治療介入，將有助於病人功能與生活品質的改善。

關鍵字

神經膠母細胞瘤 ； 腦部腫瘤 ； 腕隧道症候群 ； 復健

並列摘要

A 43-year-old woman was clinically diagnosed as carpal tunnel syndrome due to the presentation of intermittent numbness, tingling and pain in her right thumb and index finger. The symptoms gradually exacerbated together with positive Phalen's test and Tinel's sign. Endoscopic carpal tunnel release procedure failed to relieve her symptoms. Ensuing symptoms developed such as headache, extensive numbness and mild weakness in her right upper and lower limbs. MRI of brain revealed a left thalamic tumor. Stereotactic biopsy confirmed the pathologic diagnosis as glioblastoma. Post-operative radiotherapy and temozolomide chemotherapy were performed to suppress disease progression. She also received comprehensive rehabilitation program, and achieved good recovery in the locomotion ability and performance of activity of daily living. Barthel index improved from 30 to 75.
Glioblastoma multiforme (GBM) is the most common and most malignant primary brain tumor in adults, which incidence is about 3-4 of 100,000 per year. The average survival of GBM patients is 12-15 months despite available state-of-the-art multimodality treatments. GBM will cause a variety of progressive neurological deficits, including initial symptoms resembling carpal tunnel syndrome. In this case report, we also discussed medical issues encountered by patients with brain tumor during rehabilitation, and management for the systemic effects resulted from cancer, as well as the dramatic impacts on the patient, family, society, vocation and emotion.

並列關鍵字

glioblastoma ； brain tumor ； carpal tunnel syndrome ； rehabilitation