Tubbs R Shane, Oakes W Jerry
Department of Cell Biology, University of Alabama at Birmingham, USA.
Childs Nerv Syst. 2005 Mar;21(3):237-9. doi: 10.1007/s00381-003-0905-z. Epub 2004 Feb 10.
We report an 11-year-old boy who fell from an All Terrain Vehicle and sustained multiple minor soft tissue contusions and a small midthoracic laceration. Irrigation and closure of the small wound was performed at another hospital. There was no history of a penetrating wound. Within 48 h of injury, the patient developed profound dysesthesia and paralysis of the lower extremities and was transferred to our hospital. MRI disclosed a paraspinal abnormality without bony involvement. At exploration a portion of a tree branch was removed. Wound cultures were positive for Clostridium botulinum, tetani, and perfringens.
To our knowledge, this is the first case of direct Clostridium intoxication of the spinal cord in man. Moreover, this report demonstrates the invasive manner in which Clostridium toxins may breach both the intact ligamentum flavum and the dura mater to deliver their toxicity to the intradural contents. Although the patient's dysesthesia resolved and paraplegia improved to ambulation he is still left with a significant motor deficit.
我们报告一名11岁男孩，他从一辆全地形车上摔下，多处软组织轻度挫伤，胸部中部有一处小裂伤。在另一家医院对小伤口进行了冲洗和缝合。无穿透伤病史。受伤后48小时内，患者出现严重感觉异常和下肢麻痹，随后被转至我院。磁共振成像显示椎旁异常，无骨质受累。手术探查时取出了一部分树枝。伤口培养显示肉毒梭菌、破伤风梭菌和产气荚膜梭菌呈阳性。
据我们所知，这是人类首例脊髓直接梭菌中毒病例。此外，本报告证明了梭菌毒素可能以侵入性方式突破完整的黄韧带和硬脊膜，将其毒性传递至硬膜内结构。尽管患者的感觉异常得到缓解，截瘫改善至可行走，但仍存在明显的运动功能障碍。
