Pillai Sreehari Karunakaran, Subramaniam Thanu, Rao G G
Department of Internal Medicine, Amrita Institute of Medical Sciences, Kochi, India.
BMJ Case Rep. 2011 Aug 17;2011:bcr0620114373. doi: 10.1136/bcr.06.2011.4373.
A 61-year-old diabetic male developed weakness of both lower limbs while walking, 1 month go. When he was examined in hospital a hour later, it was found that he had total absence of movements in both legs, sensory loss of all modalities till umbilicus and had urinary retention. MRI spine demonstrated an intramedullary longitudinal T2 hyperintensity extending from upper thoracic cord till conus medullaris. A provisional diagnosis of transverse myelitis was made and started on corticosteroids. Partial improvement was noted over a 3 week period, after which he developed urinary infection, hyponatremia and sudden worsening of weakness. Repeat MRI spine with contrast raised the possibility of dural arteriovenous malformation leading to extensive spinal cord infarction, which was confirmed by MR angiogram.
一名61岁的糖尿病男性在1个月前行走时出现双下肢无力。1小时后在医院检查时，发现他双腿完全无法活动，脐部以下所有感觉丧失，并伴有尿潴留。脊柱磁共振成像（MRI）显示髓内纵向T2高信号，从胸段脊髓上部延伸至脊髓圆锥。初步诊断为横贯性脊髓炎，并开始使用皮质类固醇治疗。在3周内病情有部分改善，之后他出现了泌尿系统感染、低钠血症以及无力症状突然加重。增强脊柱MRI检查提示硬脊膜动静脉畸形导致广泛脊髓梗死的可能性，磁共振血管造影证实了这一诊断。
