膝下截肢手術後的頭暈與噁心

Postoperative Dizziness and Nausea after Below Knee Amputation

本文描述一位41歲女性，3年前因健檢發現肺部腫瘤，經切片確診為發炎性肌纖維母細胞腫瘤。之後因多處轉移陸續手術治療、放射線治療及標靶藥物治療。此次病人因右踝轉移性腫瘤，導致潰瘍性傷口無法癒合，且引起發燒、低血壓等敗血症症狀，經評估後按受右側膝下截肢手術。術後病患表示頭暈、噁心想吐並於3天後突然失去意識，腦部電腦斷層發現有多處轉移性腦腫瘤出血，合併阻塞性腦積水及腦幹受壓迫，病人於隔日病逝。藉由此案例報告，提供醫療人員留意。雖然發炎性肌纖維母細胞腫瘤少見腦部轉移，但若是病人有頭痛、頭暈、噁心嘔吐等症狀，仍應該要將腦部轉移放在可能診斷之中。

A 41-year-old woman who was diagnosed with inflammatory myofibroblastic tumor after lung biopsy by the health checkup 3 years ago. Multiple metastases developed during her treatment course, and the patient underwent surgeries, radiation therapy and target therapy repeatedly. This time, a metastatic tumor in her right ankle continued to progress and fungated through the skin, creating an open, persistently bleeding ulcer. The ulcer subsequently became infected and the patient exhibited signs of sepsis such as systemic fever and hypotension, therefore, necessitating a below-knee amputation was performed. After the operation, the patient started to complain of dizziness, nausea, vomiting, and suddenly lost consciousness after three days. An emergent brain CT revealed multiple brain metastasis with tumoral hemorrhage, obstructive hydrocephalus and brainstem compression. Then the patient passed away the very next day. This case report will provide a reminder to the medical and nursing staff, that although inflammatory myofibroblastic tumor rarely disseminated to the brain, brain metastasis should be kept in the differential diagnoses when patients show symptoms such as headache, dizziness, nausea and vomiting.