Higashida Tetsuhiro, Colen Chaim B, Guthikonda Murali
Department of Neurological Surgery, Wayne State University, School of Medicine, 4201 St. Antoine, 6E University Health Center, Detroit, MI 48201, USA.
Clin Neurol Neurosurg. 2010 May;112(4):353-6. doi: 10.1016/j.clineuro.2009.12.009. Epub 2010 Jan 8.
We report a case of confounding radiation myelitis to demonstrate the usefulness of surgical biopsy in ensuring the correct diagnosis and to avoid unnecessary treatment. The patient was a 40-year-old man with a history of epiglottis carcinoma and sarcoidosis. Six months after radiation therapy and chemotherapy for epiglottis carcinoma, he noticed paresthesia and dysesthesia in the left arm and leg. Two months after that, he complained of severe neck pain and rapidly progressing weakness in all extremities. MRI showed an enhanced intramedullary lesion with extensive edema in the cervical spinal cord. Radiation myelitis, intramedullary spinal tumor, and neurosarcoidosis were considered as differential diagnoses. Spinal cord biopsy with laminectomy was performed and radiation myelitis was diagnosed. After the surgery, the lesion was significantly decreased in size even though corticosteroid therapy was rapidly tapered. We emphasize that a spinal cord biopsy is indicated to obtain a pathological diagnosis and to make a clear treatment strategy for patients with associated diseases causing lesions of the spinal cord.
我们报告一例放射性脊髓炎误诊病例，以证明手术活检对于确保正确诊断及避免不必要治疗的有用性。患者为一名40岁男性，有会厌癌和结节病病史。在接受会厌癌放疗和化疗6个月后，他注意到左臂和左腿出现感觉异常和感觉障碍。两个月后，他主诉严重颈部疼痛，且四肢无力迅速进展。MRI显示颈髓内有强化病变并伴有广泛水肿。放射性脊髓炎、髓内脊髓肿瘤和神经结节病被列为鉴别诊断。遂行椎板切除脊髓活检，诊断为放射性脊髓炎。术后，尽管糖皮质激素治疗迅速减量，但病变大小显著减小。我们强调，对于导致脊髓病变的相关疾病患者，应进行脊髓活检以获得病理诊断并制定明确的治疗策略。
