Nakata Yasuhiro, Yagishita Akira, Taniguchi Makoto
Department of Neuroradiology, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu city, Tokyo 183-0042, Japan.
No To Shinkei. 2006 Jun;58(6):500-4.
We report a 66-year-old woman with a presyrinx state due to adhesive arachnoiditis. She had a history of subarachnoid hemorrhage one year ago. She became aware of gait disturbance and abnormal sensation at the chest 6 months ago. Neurological examination revealed weakness of the both lower extremities and sensory disturbance below the T6 level. MR images of the thoracic spine revealed swelling of the thoracic cord at the T3-4 level, with an intramedullary hyperintensity on T2 weighted images (WI) and hypointensity on T1-WI. The intramedullary hypointensity on T1-WI was less than the CSF intensity. In addition, the thoracic cord lower than T5 level was compressed by an arachnoid cyst in the spinal canal. The preoperative diagnosis was the presyrinx state due to adhesive arachnoiditis. An operation for detachment of arachnoidal adhesion and restoration of CSF flow pathway was performed. After one month from the operation, neurological findings were improved. Postoperative MR images revealed improvement of swelling of the thoracic cord and intramedullary abnormal intensity. The arachnoid cyst in the spinal canal was decreased in the size. The presyrinx state is recently recognized condition before the formation of syringomyelia and that is known to resolve with proper treatment. We wish to emphasize we could prevent a progression to syringomyelia by a proper treatment for the presyrinx state.
我们报告一例因粘连性蛛网膜炎导致脊髓空洞前期状态的66岁女性。她一年前有蛛网膜下腔出血病史。6个月前她开始意识到步态障碍和胸部异常感觉。神经系统检查发现双下肢无力以及T6水平以下感觉障碍。胸椎磁共振成像显示T3 - 4水平脊髓肿胀，T2加权像（WI）上髓内高信号，T1加权像上低信号。T1加权像上的髓内低信号低于脑脊液信号强度。此外，T5水平以下的胸段脊髓被椎管内的蛛网膜囊肿压迫。术前诊断为粘连性蛛网膜炎所致脊髓空洞前期状态。进行了蛛网膜粘连松解及脑脊液流动通路重建手术。术后1个月，神经学检查结果有所改善。术后磁共振成像显示胸段脊髓肿胀及髓内异常信号有所改善。椎管内的蛛网膜囊肿体积减小。脊髓空洞前期状态是最近才认识到的在脊髓空洞症形成之前的一种情况，并且已知通过适当治疗可消退。我们希望强调，通过对脊髓空洞前期状态进行适当治疗，我们能够预防其进展为脊髓空洞症。
