Lin Chih Ming
Department of Neurology, Cathay General Hospital, Hsinchu, Taiwan.
Neurol Int. 2011 Jul 5;3(2):e8. doi: 10.4081/ni.2011.e8. Epub 2011 Aug 5.
A 75-year-old Taiwanese man suffered from acute onset of right-sided extremity weakness while talking to his neighbors. He was transferred to the hospital within three-hour time after symptom onset. Initial acute ischemic cerebral infarct was diagnosed based on his symptom and cerebral computed tomography. Thrombolytic therapy was held after his symptom improved promptly and could not excluded other etiology. Thorough history taking unraveled previous Chinese medicine clinic visit because of neck sore. However, he received limited improvement after several times of massage treatment. Magnetic resnance imaging (MRI) of the cervical spine demonstrated hematoma compressing right side intradural-extramedullary space at the C2/C3 level. Through his clinical course, muscle weakness was the sole neurological finding with sparing of sensory defects. Given the close anatomy relationship between sensory and motor lamina distribution in the cervical spinal cord, our patient presented a rare manifestation. Cases of cervical spine intradural-extramedullary hematoma are not often seen and only sporadic in the documented literature. We wish, through the report of this article, to inform the first- line physicians with the following information. Among the elderly, neck sore is a common symptom. Over- stretching or overt local massage is not suggested due to relatively fragile musculature. In the clinical diagnosis and localization of lesion, cerebral or cervical spine lesion could mimic with each other and manifest hemiparesis as their first symptom. Meticulous history taking, neurological/ physical examination and pertinent laboratory work-up should be done before initiation of intravenous thrombolytic therapy as it could cause catastrophic consequences if not used properly.
一名75岁的台湾男性在与邻居交谈时突然出现右侧肢体无力。症状出现后三小时内被送往医院。根据其症状和脑部计算机断层扫描，初步诊断为急性缺血性脑梗死。在其症状迅速改善且不能排除其他病因后，溶栓治疗被暂停。详细的病史询问发现他之前因颈部疼痛去过中医诊所。然而，经过几次按摩治疗后，他的病情改善有限。颈椎磁共振成像（MRI）显示在C2/C3水平有血肿压迫右侧硬膜内髓外间隙。纵观他的临床病程，肌无力是唯一的神经学表现，感觉功能未受影响。鉴于颈髓中感觉和运动板层分布的解剖关系密切，我们的患者表现出一种罕见的症状。颈椎硬膜内髓外血肿病例并不常见，在文献记载中仅为散发病例。我们希望通过本文的报告，向一线医生传达以下信息。在老年人中，颈部疼痛是一种常见症状。由于肌肉组织相对脆弱，不建议过度伸展或过度局部按摩。在病变的临床诊断和定位中，脑部或颈椎病变可能相互模仿，并以偏瘫作为首发症状。在开始静脉溶栓治疗前，应进行细致的病史询问、神经学/体格检查及相关实验室检查，因为如果使用不当可能会导致灾难性后果。
