Okada Seiji, Saito Takeyuki, Kawano Osamu, Hayashida Mitsumasa, Matsumoto Yoshihiro, Harimaya Katsumi, Iwamoto Yukihide
Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
Spine J. 2014 Dec 1;14(12):e9-e14. doi: 10.1016/j.spinee.2014.08.449. Epub 2014 Sep 6.
Marked neurologic deterioration within a few days of traumatic spinal cord injury, known as subacute posttraumatic ascending myelopathy, is rare. Although several hypotheses regarding the pathogenesis of this condition have been proposed, the details remain elusive.
To report a case of ascending myelopathy in which a series of magnetic resonance images (MRIs) taken through the course of the illness helped follow the course of the disease and discuss possible pathogenesis.
Case report and review of the literature.
A 75-year-old woman involved in a motor vehicle collision sustained a fracture dislocation of T7-T8 with complete paraplegia below T8.
Neurologic examination and radiologic imaging taken by various means.
Posterior surgical stabilization was performed 18 hours after the injury. Both the surgical and postsurgical courses were uneventful. Four days after the injury, however, the patient reported feeling a tingling sensation in the right-hand fingers and gradually suffered from motor weakness of the upper extremities, deteriorating within a few hours to complete tetraplegia and ventilator dependence. Subsequent cervicothoracic MRI showed abrupt cord swelling with abnormal areas of signal intensity in the cervical and upper thoracic spinal cord during the interval between the onset of tingling and the development of motor paralysis in the arms. On the 20th postsurgical day, an area of hypointensity within the region of high intensity was observed on T2-weighted MRIs, indicating intramedullary spinal cord hemorrhage.
Our MRI findings suggest that systemically increased intraspinal pressure resulting from the impairment of spinal venous drainage is involved in the pathogenesis of ascending myelopathy. Although ascending myelopathy is often thought to be partly reversible, persisting increase of the intraspinal pressure may result in intramedullary hemorrhage and irreversible neurologic deficit.
创伤性脊髓损伤后数天内出现明显的神经功能恶化，即亚急性创伤后上升性脊髓病，较为罕见。尽管针对这种疾病的发病机制提出了几种假说，但具体细节仍不清楚。
报告一例上升性脊髓病病例，该病例在病程中拍摄的一系列磁共振成像（MRI）有助于追踪疾病进程，并讨论可能的发病机制。
病例报告及文献复习。
一名75岁女性在机动车碰撞事故中发生T7-T8骨折脱位，T8以下完全性截瘫。
通过多种方式进行神经学检查和影像学检查。
受伤后18小时进行了后路手术固定。手术及术后过程均顺利。然而，受伤4天后，患者报告右手手指有刺痛感，并逐渐出现上肢运动无力，数小时内病情恶化至完全性四肢瘫并依赖呼吸机。随后的颈胸段MRI显示，在刺痛开始至手臂出现运动麻痹的间隔期间，颈段和上胸段脊髓突然肿胀，信号强度异常。术后第20天，T2加权MRI在高强度区域内观察到一个低强度区域，提示脊髓内出血。
我们的MRI结果表明，脊髓静脉引流受损导致的全身脊髓内压力升高参与了上升性脊髓病的发病机制。尽管上升性脊髓病通常被认为部分可逆，但脊髓内压力持续升高可能导致脊髓内出血和不可逆的神经功能缺损。
