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16 岁运动员纤维软骨栓子致脊髓后动脉梗死

Posterior spinal cord infarction due to fibrocartilaginous embolization in a 16-year-old athlete.

机构信息

Children's National Medical Center, Washington, District of Columbia

Children's National Medical Center, Washington, District of Columbia.

出版信息

Pediatrics. 2014 Jul;134(1):e289-92. doi: 10.1542/peds.2013-2468.

Abstract

Spinal cord infarction is extremely rare in children, and, similar to cerebrovascular infarcts, the pathogenesis is different from adults. Spinal cord infarcts are most commonly reported in adults in the context of aortic surgery; in children, the etiology is frequently unknown. Fibrocartilaginous embolization is a potential cause of spinal cord infarct in both populations. It is a process that occurs when spinal injury has resulted in disc disease, and subsequently disc fragments embolize to the cord, resulting in ischemia and/or infarction. In this report, we present a 16-year-old athlete who presented with symptoms of acute myelopathy after a period of intense exercise. Our original concern was for an inflammatory process of the spinal cord; however, given her history of competitive tumbling and degenerative disc changes on her initial spine magnetic resonance imaging scan, diffusion-weighted imaging was performed, which demonstrated acute spinal cord infarction. Unlike many cases of spinal cord infarction, our patient was fortunate to make a near-complete recovery. This case highlights the importance of recognizing rare causes of spinal cord pathology and considering infarction in the differential diagnosis of acute myelopathy because management and prognosis varies.

摘要

脊髓梗死在儿童中极为罕见,与脑血管梗死类似,其发病机制与成人不同。脊髓梗死在接受主动脉手术的成年人中最为常见;在儿童中,病因通常未知。纤维软骨栓子栓塞是这两个群体中脊髓梗死的潜在原因。这是一种发生在脊柱损伤导致椎间盘疾病的过程,随后椎间盘碎片栓塞到脊髓,导致缺血和/或梗死。在本报告中,我们介绍了一位 16 岁的运动员,她在剧烈运动后出现急性脊髓病症状。我们最初的关注点是脊髓的炎症过程;然而,鉴于她有竞技翻滚的病史和初始脊柱磁共振成像扫描显示的退行性椎间盘变化,我们进行了弥散加权成像,结果显示急性脊髓梗死。与许多脊髓梗死病例不同,我们的患者很幸运地几乎完全康复。这个病例强调了认识罕见的脊髓病变原因的重要性,并考虑到在急性脊髓病的鉴别诊断中存在梗死,因为管理和预后不同。

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