摘要：

目的 总结以神经系统症状首发的脑膜癌患者的临床特征。方法 收集2009年6月至 2017年12月确诊为脑膜癌患者的临床资料，对其临床、实验室及影像学表现进行归纳分析。结果 86.96%（20/23）患者以头痛首发，52.17%（12/23）为头痛伴呕吐。MRI增强扫描病灶明显强化，59.09% （13/22）伴脑室系统扩大；CT表现为幕上脑室系统扩大（1例）。肿瘤原发灶主要源于肺癌，约占65.22% （15/23），其他来源为结肠癌、淋巴瘤、胃癌和星形细胞瘤（腰髓）各占4.35%（1/23），来源不详者占17.39% （4/23）。脑脊液压力明显升高者占82.61%（19/23）；肿瘤标志物以癌胚抗原升高者较为多见，血清筛查 为11/17例、脑脊液为7/10例。结论 脑膜癌临床症状以头痛伴呕吐常见；影像学检查主要表现为脑膜强化或伴交通性脑积水；实验室检查以颅内高压为特征性改变，血清和脑脊液肿瘤标志物癌胚抗原明显升高。原发灶主要来源于肺癌，脑脊液细胞学检出肿瘤细胞为诊断“金标准”。

关键词: 脑膜肿瘤, 肿瘤转移, 磁共振成像, 生物标记, 肿瘤

Abstract:

Objective To investigate the clinical characteristics of meningeal carcinomatosis with nervous system syndrome as initial symptom. Methods Clinical data, laboratory and imageing examinations were retrospectively analyzed in 23 patients of meningeal carcinomatosis from June 2009 to December 2017. Results Twenty patients (86.96%) had headache as initial symptom and 12 (52.17%) had headache with vomiting. Head enhanced MRI showed obvious enhancement in meningeal lesions, and 13 cases (59.09%) had meningeal enhancement with enlargement of ventricular system; CT showed enlargement of supratentorial ventricular system (1 case). About 65.22% (15/23) primary lesions were originated from lungcancer,and others were or iginated from colon cancer,hematological lymphoma, gastric cancer, spinal astrocytoma (4.35%, 1/23 respectively), and some unknown origin (17.39%, 4/23). About 82.61% (19/23) patients cerebrospinal fluid pressure increased obviously, Tumor markers especially carcinoembryonic antigen (CEA) were mostly increased in serum (11/17) and cerebrospinal fluid (7/10). Conclusions Headache and vomiting are the most common clinical symptoms of meningeal carcinomatosis. Enhanced MRI shows meningeal enhancement or communicating hydrocephalus. Cerebrospinal fluid pressure tends to increase significantly. Carcinoembryonic antigen is significantly increased in serum and cerebrospinal fluid. Primary lesions of meningeal carcinomatosis mostly originate fromlungcancer. Finding tumor cells in cerebrospinal fluid is the " golden standard" of diagnosis.

Key words: Meningeal neoplasms, Neoplasm metastasis, Magnetic resonance imaging, Biomarkers,tumor