Endovascular Thrombectomy for Acute MCA Occlusion Caused by Tumor Embolus of Rhabdomyosarcoma: A Case Report

動脈取栓術於橫紋肌肉瘤的瘤栓致急性中大腦動脈栓塞：一病例報告

傅傳修(Chuan-Hsiu Fu) ； 湯頌君(Sung-Chun Tang) ； 鄭建興(Jiann-Shing Jeng)

《台灣中風醫誌》 1卷1期 (2019/06) Pp. 70-75

https://doi.org/10.6318/FJS.201906_1(1).0008

摘要

Background: Cerebral tumor embolism is a rare stroke etiology among cancer patients with cancer-related thrombosis. Here, we reported one case with rhabdomyosarcoma, who presented with acute right middle cerebral artery (MCA) occlusion caused by tumor emboli and treated successfully with suction thrombectomy. Case Report: A 32-year-old woman, with epitheloid rhabdomyosarcoma of the left thigh and multiple lung metastases, presented with acute onset left upper limb weakness and disorganized speech. Brain CT angiography showed partial occlusion of the right distal M1 segment of the MCA and suspected brain metastases at the right temporo-parietal lobe. Intravenous thrombolysis was not indicated for intra-axial brain tumor. Endovascular thrombectomy was not performed initially due to possible brain tumor related seizure and low NIHSS score. However, her symptoms progressed (NIHSS from 6 to 12) 2 hours 45 minutes after symptoms onset and suction thrombectomy was performed in the right M1 with TICI 2b immediately. The retrieved embolus reported metastatic epitheloid rhabdomyosarcoma pathologically. Her neurological status improved in 3 days with mild anomic aphasia. (NIHSS = 1) However, the patient died 1 week after the stroke onset due to acute respiratory failure. Conclusion: Hitherto, acute large cerebral arterial occlusion caused by tumor embolus by epitheloid rhabdomyosarcoma has not been reported. Although there is a high risk of recurrent systemic tumor embolization and poor survival outcome, endovascular thrombectomy is effective in achieving revascularization and improving ischemic neurological deficit.

關鍵字

cancer ； ischemic stroke ； rhabdomyosarcoma ； tumor embolism

並列摘要

背景：在癌症合併急性缺血性中風，腫瘤栓子致急性大腦動脈栓塞十分罕見。此病例報告將呈現因瘤栓引起右中大腦動脈栓塞後，成功接受經動脈取栓術的橫紋肌肉瘤個案。病例報告：32歲女性被診斷左大腿之上皮樣橫紋肌肉瘤併多處肺部轉移，呈現突發左上肢無力及語言表達困難，腦部電腦斷層血管攝影顯示右側中大腦動脈第一段血管阻塞，同時新發現一右側顳－頂葉處的轉移性腦瘤。軸內腦瘤為血栓溶解治療禁忌故未施打。因無法排除腦腫瘤引起之癫癇及相對輕微的臨床症狀，未在第一時間考慮動脈取栓術。然而，病人因初始症狀2小時45分鐘後症狀惡化，美國國家衛生院腦中風量表分數由6分進展至12分，因此施予抽吸取栓術，於取栓術開始起算7分鐘內移除右中大腦動脈之血栓，重新開通血管（TICI 2b），取出血栓的病理報告為轉移性橫紋肌肉瘤。3天後病人的神經功能缺損進步至只有輕微命名困難。然而，病人因急性呼吸衰竭惡化，於中風1週後病逝。結論：迄今，尚未有病例報告過上皮樣橫紋肌肉瘤之瘤栓引起的急性腦部大動脈栓塞。雖然病人因癌症末期預後不佳及具全身多處栓塞之風險。經動脈取栓術在瘤栓引起之大血管急性腦中風仍為一有效開通血管及改善神經學症狀的治療方式。

並列關鍵字

癌症 ； 缺血中風 ； 腫瘤栓子 ； 橫紋肌肉瘤