一位77歲肺癌女性以初次癲癇表現

First-Onset Seizure in a 77-Year-Old Woman with Lung Cancer: A Case of Leptomeningeal Metastasis

軟腦膜轉移（Leptomeningeal Metastasis）是一種罕見且為晚期的癌症併發症，預後不良且治療選擇有限。本案例是一位77歲罹患非小細胞肺癌女性病人，因初次出現癲癇發作，初步懷疑診斷為腦轉移、中樞神經感染等，但仍間歇性癲癇發作，而腦部磁振造影無特殊徵兆，在腦脊髓液細胞學分析出惡性腫瘤細胞，確診軟腦膜轉移，經口服第三代標靶藥物、抗癲癇藥、症狀及良好營養控制下，最終仍多重器官衰竭而逝世。因此，建議罹患非小細胞肺癌的肺腺癌末期病人時，特別是符合表皮生長因子受體（Epidermal Growth Factor Receptor）突變者，當出現神經學症狀時，即使腦部/脊椎磁振造影檢查無典型影像，仍需將軟腦膜轉移列為鑑別診斷之一，以達及時診斷治療，改善不良預後。

Leptomeningeal metastasis (LM) is a rare, late-stage complication of cancers associated with poor prognosis and limited treatment options. We report the case of a 77-year-old woman with non-small cell lung cancer (NSCLC), who experienced first-onset seizure. Initial differential diagnoses revealed a suspicion of brain metastasis and central nervous system infection. However, despite the patient experiencing intermittent seizures, brain magnetic resonance imaging (MRI) did not reveal any significant abnormalities. Cytological analysis of the cerebrospinal fluid revealed the presence of malignant tumor cells, confirming LM. Despite receiving third-generation targeted therapy, antiseizure drugs, symptomatic management, and good nutritional support, the patient died of multiorgan failure. This case highlights the importance of considering LM in the differential diagnosis of neurological symptoms in patients with advanced NSCLC, particularly those harboring epidermal growth factor receptor mutations. Even in the absence of definitive findings in spine and brain MRIs, early diagnosis and timely intervention may improve the prognosis of NSCLC patients having LM.