Clinical Analysis of Lung Cancer with Brain Metastases Misdiagnosed as Cerebral Hemorrhage

OUYANG Kui; LIANG Peiri; WU Tingguo; ZHOU Jingxia

doi:10.3969/j.issn.1002-3429.2023.09.001

Abstract：Objective To summarize the clinical characteristics of lung cancer with brain metastases and to explore the causes of misdiagnosis of lung cancer with brain metastases with cerebrovascular symptoms as the initial manifestation.Methods The clinical data of 9 misdiagnosed cases of lung cancer with brain metastases admitted from October 2019 to Janu-ary 2022 were retrospectively analyzed.Results In this group,9 patients were treated for acute headache,progressive unilat-eral limb movement disorder,slurred speech,unsteady gait,vomiting and mild consciousness disturbance.Physical examina-tion showed emaciation,high blood pressure,unilateral limb weakness,and reduced muscle tone.Cerebrospinal fluid pres-sure increased in 9 patients.There were 3 patients with papillary edema of optic nerve,and routine CT examination of the head of 9 patients showed uniform high-density images with blurred boundaries and edema bands.The initial diagnosis was cerebral hemorrhage(small amount)and symptomatic treatment such as cranial pressure reduction and dehydration was not ef-fective.After being transferred to our hospital,cranial CT re-examination was performed,and chest X-ray and CT examination revealed clumpy shadow in the left upper lung.Four patients were confirmed as central lung cancer in the left upper lung by fi-berbronchoscopy biopsy and 5 patients were confirmed as lung cancer with brain metastasis by CT-guided percutaneous lung bi-opsy.The duration of misdiagnosis was 9-13 d.After diagnosis,9 patients were treated with surgical resection combined with postoperative chemoradiotherapy.The patients were generally in good condition after surgery,and all survived at 3-month fol-low-up without recurrence.Conclusion The symptoms of lung cancer are varied.The lung symptoms of patients having lung cancer with brain metastases and cerebrovascular symptoms as the initial manifestation are not obvious or absent,and lack spe-cific symptoms and signs,which is,therefore,more likely to be misdiagnosed as cerebrovascular accident.To strengthen the understanding and vigilance of clinicians on lung cancer with brain metastasis,middle-aged and elderly patients with cerebro-vascular symptoms as the initial manifestation and poor conventional treatment efficacy,should consider the possibility of meta-static cancer and further screening of the primary lesion should be performed to reduce the misdiagnosis rate.