病 案
Case Study:Pediatric Brain Tumor
Mr Jiang,male,age 6
Complaint:This patient，a previously healthy and active 6-year-old，woke up one morning complaining that his head hurt.He had a few episodes of vomiting early in the morning，and he was not able to walk straight when he got out of bed.His parents took him to the pediatrician，who，after noting the headache，morning emesis,and progressive loss of muscle coordination(ataxia1)),conducted a brief examination and then made an immediate referral to a neurologist2).
Examination:Before talking with the patient，the neurologist spoke with the boy’s patients to obtain a prior medical history.They stated that he had a healthy childhood thus far with normal illnesses such as earache3)，a few colds，and sore throat.The parents indicated that this patient is a first grader and attends a public elementary school.They said he loves school and baseball.The latter is his favorite extracurricular activity4).
The neurologist spoke with the patient and explained what he was going to do.Next he performed a thorough neurologic examination.Then he offered to the patient a simple explanation of the tests he was going to order.Finally，he answered all of the patient’s and parents’ questions.
Clinical Course:The parents of the boy took him to the radiology department5) of the hospital for a scheduled MRI.The radiologist reported the scan revealed some dense tissue indicating a suspicious mass6).A lumbar puncture7)(LP)was performed，which revealed some suspicious cells in the cerebrospinal fluid8)(CSF).
The patient had a craniotomy9) with tumor resection five days later.The cerebellar tumor was found to be noninfiltrating10) and was enclosed within a cyst，which was totally removed.The patient spent two days in the neurologic intensive care unit11)(NICU)because he was on seizure precautions and monitoring for increased in tracranial pr essure12)(ICP).A regimen of focal radiation followed after recovery from surgery.His spine was also treated because of the potential spread of tumor cells in the CSF.The patient did not have chemotherapy because of the danger that hydrocephalus13) might develop,which generally requires a ventriculoperitoneal(VP)shunt14).
Follow-Up:
The patient was discharged six days after his surgery with mild hemiparesis，which was expected to resolve within the next few weeks.He was scheduled for six weeks of outpatient rehabilitation，and his prognosis was good.The pediatric physical and occupational therapists were able to motivate the boy by playing therapeutic games with him，including using a baseball and having him “walk and run the bases.” The patient was looking forward to rejoining his baseball team next season.
注释：
1）ataxia 共济失调，运动失调，混乱，无秩序
2）neurologist 神经学家，神经科医师(https://www.daowen.com)
3）earache 耳朵痛，耳痛
4）extracurricular activity 课外活动
5）radiology department 放射科
6）suspicious mass 可疑的肿块
7）lumbar puncture 腰椎穿刺
8）cerebrospinal fluid 脑脊液
9）craniotomy 穿颅术，颅骨切开术
10）noninfiltrating 非浸润的
11）neurologic intensive care unit 神经重症监护病房
12）increased intracranial pressure 颅内压增高
13）hydrocephalus 脑积水
14）ventriculoperitoneal shunt 脑室-腹膜腔内分流术