Sant'Anna G M, Azevedo C T, Simas A, Castro B P, Bhering C A
McMaster Children's Hospital, 1200 Main Street West, Hamilton, Ontario, Canada.
Dev Med Child Neurol. 2007 Jul;49(7):539-41. doi: 10.1111/j.1469-8749.2007.00539.x.
The case of a term, male neonate (birthweight 3785g) with cephalic presentation, Caesarean-section (C-section) delivery, and failure to thrive is reported. The infant presented with generalized hypotonia and respiratory failure immediately following birth. An initial diagnosis of hypoxic-ischemic encephalopathy was made. However, ventilator dependency and slow recovery of generalized tonus over the following weeks could not be explained. Late cervical magnetic resonance imaging showed extensive syringomyelia from C2 to C7. To the authors' knowledge, this is the first report of syringomyelia after a C-section delivery following cephalic presentation without any associated abnormalities. Follow-up at 2 years of age revealed no improvement on neurological examination: poor head control, difficulty swallowing, flaccid paralysis of upper limbs, and spasticity of lower limbs with exacerbated deep reflexes and spontaneous clonus. Difficulties in establishing the diagnosis and managing the case are discussed.
本文报告了一例足月儿男婴（出生体重3785g），头先露，剖宫产娩出，且发育迟缓。该婴儿出生后即刻出现全身肌张力低下和呼吸衰竭。初步诊断为缺氧缺血性脑病。然而，在接下来的几周里，呼吸机依赖以及全身肌张力恢复缓慢的情况无法得到解释。后期颈椎磁共振成像显示C2至C7节段广泛的脊髓空洞症。据作者所知，这是头先露剖宫产术后无任何相关异常而发生脊髓空洞症的首例报告。2岁时的随访显示神经学检查无改善：头部控制不佳、吞咽困难、上肢弛缓性麻痹以及下肢痉挛，伴有深反射亢进和阵挛。文中讨论了该病例诊断和处理的困难之处。
