Fukao Shigeharu, Hanakita Junya, Kitahama Yoshihiro, Ando Naoto, Minami Manabu
Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Fujieda, Shizuoka.
Neurol Med Chir (Tokyo). 2009 Nov;49(11):539-41. doi: 10.2176/nmc.49.539.
An 84-year-old man presented with a rare case of spinal epidural granuloma with intratumoral hematoma resulting in acute paraplegia. He was admitted to our hospital because of lumbago and hematemesis following a fall 10 days before. Progressive paraparesis occurred 2 days after admission. Neurological examination showed paraplegia and hypesthesia below the T10 level. Thoracic radiography revealed some spondylotic changes of the thoracic vertebrae without osteolytic changes. Sagittal T(1)- and T(2)-weighted magnetic resonance imaging of the thoracic spine demonstrated a hyperintense epidural mass lesion compressing the dorsal portion of the thoracic spinal cord at T10-11 space. Emergency laminectomy was performed, and the epidural encapsulated hematoma and elastic yellowish mass adhered to the dura mater were totally removed. Histological examination of the excised specimens showed a granuloma. Motor weakness improved after surgery, and he could walk with a cane about 3 months after surgery. The minor spinal injury probably caused intratumoral hemorrhage within a previous epidural granuloma, suddenly resulting in the paraplegic symptoms.
一名84岁男性患者，出现罕见的脊髓硬膜外肉芽肿合并瘤内血肿，导致急性截瘫。他因10天前跌倒后出现腰痛和呕血而入院。入院2天后出现进行性双下肢轻瘫。神经系统检查显示T10水平以下截瘫和感觉减退。胸部X线检查显示胸椎有一些脊柱关节病改变，但无骨质溶解改变。胸椎矢状位T1加权和T2加权磁共振成像显示，在T10 - 11间隙有一个高信号硬膜外肿块病变，压迫胸段脊髓背侧部分。进行了急诊椎板切除术，完全切除了硬膜外包裹性血肿和附着于硬脑膜的弹性淡黄色肿块。切除标本的组织学检查显示为肉芽肿。术后运动无力有所改善，术后约3个月他可以拄着拐杖行走。轻微的脊柱损伤可能导致先前硬膜外肉芽肿内瘤内出血，突然导致截瘫症状。
