脊椎內腫瘤伴隨交通性水腦症：病例報告

Intraspinal Tumor Associated with Hydrocephalus: A Case Report

蘇聖翔(Sheng-Hsiang Su) ； 洪國盛(Kuo-Sheng Hung) ； 洪禎雯(Jen-Wen Hung)

《台灣復健醫學雜誌》 33卷2期 (2005/06) Pp. 111-115

https://doi.org/10.6315/2005.33(2)07

摘要

脊椎內腫瘤伴隨交通性水腦症並不常見，特別是病人在臨床上常會先出現水腦症的病徵：包括步態不穩，尿失禁，癡呆，頭痛，視乳頭水腫等等，更造成正確診斷的難度。本文主要是提出一位七十七歲男性，因臨床上有步行困難，痴呆及譫妄的現象，經腦部電腦斷層檢查顯示為交通性水腦症，故接受腦室腹膜引流管手術。手術後意識狀態改善，但雙側下肢無力卻繼續惡化，經脊髓核磁共振檢查，顯示在腰椎有一個脊椎內腫瘤。手術移除腫瘤後發現為轉移性的脊髓腺瘤合併水腦。臨床上若發現病人有水腦的表現，若有其他不合理之神經症狀，應進行更進一步檢查，不應以正常腦壓之水腦症視之，而延誤診斷。

關鍵字

脊椎內腫瘤 ； 水腦症 ； 癡呆

並列摘要

Intraspinal tumor associated with hydrocephalus is a well known but uncommon phenomenon. It is difficult to diagnose accurately if clinical hydrocephalus symptoms are presented, comprising unsteady gait, urinary incontinence, dementia, headache and papilledema. The patient in this study was a 77 years old male whose main problems included impaired walking, dementia and delirium. He received V-P shunt because of brain CT disclosing communicating hydrocephalus. Patient consciousness improved following operation, but bilateral lower limb weakness became worse. Following spinal MRI examination, an intraspinal tumor at L1 level was noted. The patient underwent laminectomy and partial tumor removal, but metastatic intraspinal adenocarcinoma was identified through pathology. Intraspinal tumor should be included among different possible diagnoses of dementia and communication hydrocephalus if no precise origin is noted. This case study aimed at reminding the clinician the possibility of a combined presentation of hydrocephalus and intraspinal tumor.

並列關鍵字

intraspinal tumor ； hydrocephalus ； dementia