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患者,男性,78岁,因双下肢麻木、无力4个月,大小便失禁8天,于1997年6月20日入院.患者4个月前首先感左下肢麻木无力,半月后又出现右下肢麻木、无力,病情进行性加重,由扶杖行走至完全不能行走.8天前又出现大小便失禁.另因进行性咽下困难于2月前发现食管癌(中段),行放射治疗至今.查体:血压16/11kPa,心、肺、腹无异常发现.神经系统检查:意识清,无力体型,颅神经正常,颈软,双上肢肌力、肌张力正常,左下肢肌力Ⅱ级,右下肢肌力Ⅳ级,肌张力减低,腱反射减弱,未引出病理反射,平脊髓T_9平面以下痛觉、深感觉减退,伴括约肌功能障碍.颈、胸、腰椎棘突无压痛及叩击痛,局部无红肿,脊柱无侧弯及后凸畸形.实验室检查:血糖、肝功、肾功、脑电图检测和肝、胆、胰、脾、肾B超检查以及x线胸片均无异常.腰穿脑脊液压力1.36kPa,白细胞数18×10~6/L,淋巴细胞0.61,蛋白轻度升高(0.58g/L),压颈试验示椎管通畅.MRI检查提示T_6～T_8脊髓节段变性.最后诊断:食管癌,副肿瘤性脊髓变性.给予激素、维生素及营养支持治疗10余天,病情无改善,因经济困难,自动出院.讨论 副肿瘤综合征是指肿瘤在无转移的情况下影响远隔器官的功能的临床症象.其发病机理目前尚未阐明,考虑与以下几种因素有关:(1)肿瘤组织某成分所引起的自身免疫抗体的作用;(2)?
Patient, male, 78 years old, with numbness and weakness in both lower extremities for 4 months, incontinence for 8 days, admitted to hospital on June 20, 1997. The patient first felt numbness in the left lower extremities 4 months before, and right lower extremities appeared after a half months. With numbness and weakness, the condition progresses progressively, walking from the pole to complete walking. Incontinence occurred again 8 days ago. In addition, due to progressive dysphagia, esophageal cancer (middle segment) was discovered 2 months ago. Physical examination: Blood pressure 16/11kPa, no abnormalities found in heart, lung, abdomen. Nerve system examination: clear consciousness, incompetent body type, normal cranial nerves, soft neck, normal upper limb muscle strength, muscle tone, left lower limb muscle strength class II, Right lower limb muscle strength IV, reduced muscle tone, reduced tendon reflexes, no pathological reflexes, flat spinal cord below the T_9 plane pain, deep hypoesthesia, with sphincter dysfunction. Neck, chest, lumbar spinous process without tenderness and percussion pain, No local swelling, no scoliosis and kyphotic deformity. Laboratory tests: blood glucose, liver function, renal function, electroencephalogram detection and liver, gallbladder, pancreas, spleen, kidney B-ultrasound and x-ray are not abnormal Lumbar cerebrospinal fluid pressure 1.36kPa, leukocyte count 18×10~6/L, lymphocyte 0.61, slightly elevated protein (0.5 8g/L), neck compression test showed vertebral canal patency. MRI examination suggested T_6 ~ T_8 segmental degeneration of the spinal cord. Final diagnosis: esophageal cancer, paraneoplastic spinal cord degeneration. Give hormones, vitamins and nutritional support for more than 10 days, no improvement in the condition Due to economic difficulties, it is automatically discharged from the hospital. Discussing paraneoplastic syndrome refers to the clinical symptoms of a tumor affecting the functions of distant organs without metastasis. The pathogenesis of this disease has not yet been elucidated. Consider the following factors: ) The role of autoimmune antibodies caused by a component of tumor tissue; (2)?