临床理由：一位60岁男性，快速进行性左半身无力和视力丧失。

IF 8.5 1区医学 Q1 CLINICAL NEUROLOGY

Neurology Pub Date : 2025-06-23 DOI:10.1212/wnl.0000000000213869

Matthew Rock,Shannon C Shipley,Jessica N Little,Joseph R Berger,Denise J Xu

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引用次数: 0

摘要

60岁男性患者表现为2周进行性左侧无力、构音障碍和不协调的左同音偏盲，MRI显示右脑脑蒂、视光辐射和中脑背侧病变。血清和脑脊液检测基本无显著差异。他的虚弱迅速恶化，短间隔重复成像显示脑干异常扩张。对炎症、感染、肿瘤和副肿瘤原因的系统调查最终得出了诊断。该病例提供了对非典型脑干病变的全面鉴别，这可能会造成诊断困境，特别是当脑脊液研究不明确且位置不适合活检时。在这种情况下，包括全身成像在内的系统方法可以帮助诊断。

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Clinical Reasoning: A 60-Year-Old Man With Rapidly Progressive Left Hemibody Weakness and Vision Loss.

A 60-year-old man presented with 2 weeks of progressive left-sided weakness, dysarthria, and an incongruous left homonymous hemianopsia, with MRI brain showing a lesion involving the right cerebral peduncle, optic radiation, and dorsal midbrain. Serum and CSF testing was largely unremarkable. His weakness worsened rapidly, and short-interval repeat imaging demonstrated expansion of the brainstem abnormality. A methodical investigation of inflammatory, infectious, neoplastic, and paraneoplastic causes ultimately yielded the diagnosis. This case provides a comprehensive differential for atypical brainstem lesions, which can pose a diagnostic dilemma, particularly when CSF studies are unrevealing and the location is not amenable to biopsy. In such situations, a systematic approach, including whole-body imaging, can aid in diagnosis.

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来源期刊

Neurology 医学-临床神经学

CiteScore

12.20

自引率

4.00%

发文量

1973

审稿时长

2-3 weeks

期刊介绍： Neurology, the official journal of the American Academy of Neurology, aspires to be the premier peer-reviewed journal for clinical neurology research. Its mission is to publish exceptional peer-reviewed original research articles, editorials, and reviews to improve patient care, education, clinical research, and professionalism in neurology. As the leading clinical neurology journal worldwide, Neurology targets physicians specializing in nervous system diseases and conditions. It aims to advance the field by presenting new basic and clinical research that influences neurological practice. The journal is a leading source of cutting-edge, peer-reviewed information for the neurology community worldwide. Editorial content includes Research, Clinical/Scientific Notes, Views, Historical Neurology, NeuroImages, Humanities, Letters, and position papers from the American Academy of Neurology. The online version is considered the definitive version, encompassing all available content. Neurology is indexed in prestigious databases such as MEDLINE/PubMed, Embase, Scopus, Biological Abstracts®, PsycINFO®, Current Contents®, Web of Science®, CrossRef, and Google Scholar.