確定診断の困難であつた多発性脳神経麻痺について—剖検により初めてびまん性転移性髄膜癌腫症と判明した1症例

MULTIPLE CRANIAL NERVE PARALYSIS

　I．はじめに

　多発性脳神経麻痺を来たす原因はいくつかあるが，癌の頭蓋内転移もその1つに数えられる。

　癌の頭蓋内転移すなわち脳転移には大別して2つのタイプがあり，その1つは脳実質内への転移で腫瘍塊形成性のタイプ，もう1つは軟髄膜（leptomeninx）すなわち脳軟膜およびクモ膜下腔への転移で播種状またはびまん性浸潤性のタイプである。

　A case of multiple cranial nerve paralysis, in a 48-year-old male patient is reported. The patient suffered peripheral facial palsy of the right side which was followed by complicated manifestation of progressive clinical symptoms. The patient died 5 months later.

　There was no abnormal finding in the examination of the cerebrospinal fluid nor in the X-ray examination of the chest ; final diagnosis was clinically undetermined.

　However, the postmortem examination showed metastasis of the primary lung cancer to the pia-arachnoid of the brain forming a silent phase of small cell anaplastic carcinoma.

　The final diagnosis was considered as diffuse metastatic leptomeningeal carcinoma.