不做核磁共振，这病不太好定。如此看来，大家也就别再抱怨医生把医疗费用整高了，不高能查出病来吗？

Case 1 (part 4)

The patient was a 43-year-old, right-handed woman who presented in 1991 with a 1-year history of intermittent paresthesias in both hands.  This was not accompanied by numbness or weakness and the paresthesias intensified over the 6 weeks prior to her admission.  In the month prior to admission, she began to experience paresthesias of the right leg and a sensation of heaviness in both legs.  She had trouble keeping up with her young children and had a tendency to drag the right leg.  She also developed paresthesias in the perineal region without any disturbance of bowel or bladder function.  The patient thought her memory was unaffected, but she acknowledged that she did not feel mentally clear.  She had no headaches, visual or bulbar symptoms and no back pain.

The patient did not smoke or drink alcohol. There had been no recent travel. She had no prior neurologic symptoms or medical illnesses. There was no history of hypertension, diabetes, or any chronic illness. She did not take any medications. There was no family history of neurologic disease.

On examination her blood pressure was 110/70. She was afebrile. Her pulse was 90 and regular. The patient looked healthy and fit and was in no distress. Her general medical examination was entirely normal including rectal tone and anal wink. On neurologic exam, mental status and cranial nerves were normal. Motor testing revealed a mild right hemiparesis as evidenced by slowed rapid alternating movements in the right hand, as well as mild weakness of wrist extension and intrinsic muscles of the right hand. She had mild weakness of flexion and extension of the right foot and the hamstring muscles on the right. All primary sensory modalities were intact to formal testing, although the patient did have an ill-defined allodynia in the right leg. Stereognosis was normal. Her gait was normal save for reduced arm swing on the right and inability to walk on her heels with her right foot. Reflexes were notable for being diffusely brisk throughout the right arm and leg but no Babinski was evident.

Complete blood count, electrolytes, hepatic and renal function tests were normal. A cranial MR scan was performed which revealed an extensive non-enhancing mass primarily confined to the white matter (Figure). The lesion predominantly involved the left centrum semiovale but crossed the corpus callosum and involved the right side as well. Later, the patient underwent a stereotactic needle biopsy.

Diagnosis: Low grade oligodendroglioma

      (a)                                                                         (b)

Fig.  T2-weighted MR images demonstrating an extensive, infiltrative, bilateral tumor (a).

The lesion has substantially diminished in size after chemotherapy (b).