Yano Shunsuke, Hida Kazutoshi, Seki Toshitaka, Iwasaki Yoshinobu, Akino Minoru, Saitou Hisatoshi
Department of Neurosurgery, Hokkaido University Graduate School of Medicine, North 15, West 7, Kita-ku, Sapporo 060-8638, Japan.
No Shinkei Geka. 2003 Dec;31(12):1297-301.
Thoracic disc herniation is less common rather than cervical or lumbar herniation. Cases of sudden onset without trauma are especially rare. Generally, the neurological onset of disc herniation is caused by mechanical cord compression due to a protruded disc, and its onset is usually gradual. Ischemia is also considered as a factor of neurological onset. We report a case of a 78-year-old male with sudden paraplegia while straining at the toilet. T2 weighted MR image on admission showed mild disc protrusion at the level of Th8-9 and intramedullary high signal intensity below the Th8-9 level. We speculate that Valsalva-like maneuver had led to the congestion of vertebral venous plexus or compression of the anterior spinal artery, and spinal ischemia occurred.
胸椎间盘突出症比颈椎或腰椎间盘突出症少见。无创伤的突发病例尤其罕见。一般来说，椎间盘突出症的神经症状是由突出的椎间盘对脊髓的机械性压迫引起的，其发病通常是渐进性的。缺血也被认为是神经症状发作的一个因素。我们报告一例78岁男性，在如厕用力时突然出现截瘫。入院时的T2加权磁共振图像显示胸8 - 9水平有轻度椎间盘突出，胸8 - 9水平以下脊髓内高信号。我们推测，类似瓦尔萨尔瓦动作导致了椎静脉丛充血或脊髓前动脉受压，进而发生脊髓缺血。
