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Journal of the Korean Neurological Association 1992;10(4): 539-549.
원발암이 진단되기 전에 나타난 수막전이에 대한 연구
나덕렬, 이원용,노재규,박성호,이광우,아상복,명호진,전범석
서울대학교 신경과. 콜롬비아대학교 신경과.
Leptomeningeal Metastasis Presented before Primary Cancer
Duk-Lyul Na, M.D., Won-Yong Lee, M.D., Jae-Kyu Roh, M.D., Seong-Ho Park, M.D., Kwang-Woo Lee, M.D., Sang-Bok Lee, M.D., Ho-Jin Myung, M.D., Beon-Seok Jeon, M.D.
Department of Neurology, College of Medicine, Seoul National University, Department of Neurology, College of Medicine, Columbia University
Abstract
Leptomeningeal metastasis (LM) usually occurs in patients with previous cancer. But rarely it can be the first manifestation of cancer. We analyzed primary tumors and early clinical findings in 12 patients in whom LM was the presenting sign of cancer. Primary tumors were lung cancer in 5 cases, stomach cancer 1, Iymphoma 1 and unknown 5. Most patients, previously healthy, developed progressive headache which was followed by symptoms and signs involving multiple neuraxis. Major symptoms on admission were headche, nausea, vomiting, visual dimness, diplopia, hearing destrubance and the major neurologic deficits were papilledema, ocular motor palsy, facial palsy, decreased DTR and neck stiffness. From these clinical findings and CSF test, initially LM was suspected in only 6 patients. In the remaining 6 patients, initial diagnoses were tuberculous meningitis(3), benign intracrnial hypertension(2) and adjustment disorder(1). In addtition to cytology, which was positive in 9 cases, CSF carcinoembryonic antigen (CEA) and neuroimaging played important role in the early diagnosis of LM.