Nitta Eishun, Sakajiri Kenichi, Kawashima Atsuhiro
Department of Neurology, National Hospital Organization Kanazawa Medical Center.
Rinsho Shinkeigaku. 2015;55(9):646-50. doi: 10.5692/clinicalneurol.cn-000699. Epub 2015 Jul 11.
A 66-year-old man was admitted to our hospital with acute paraplegia. He has suffered from hypertension with renal dysfunction for 7 years. Five months before admission, hemodialysis was introduced to him because of chronic renal failure due to renal sclerosis. One week before hospitalization, he noticed dizziness, sensory disturbance below the chest, and a urinary difficulty. Two days prior to admission, he could not walk independently. Spinal MRI revealed a mass at the 7th level of the cervical spine, showing low intensity on T(1)-weighted image and surrounding hypointensity with inner mixed intensity on T(2)-weighted image. An urgent surgery removed the cervical epidural mass and the following pathological evaluation established the diagnosis of β2-microglobulin amyloidoma. Hemodialysis-related amyloidoma generally emerges after a long duration of hemodialysis, demonstrates an insidious onset of symptoms, and is very rare. The current case indicates that we need to be aware of the possibility of β2-microglobulin amyloidoma even in patients with a short history of hemodialysis with a rapid presentation.
一名66岁男性因急性截瘫入住我院。他患有高血压伴肾功能不全7年。入院前5个月,因肾硬化导致慢性肾衰竭开始接受血液透析。住院前一周,他出现头晕、胸部以下感觉障碍及排尿困难。入院前两天,他无法独立行走。脊柱磁共振成像(MRI)显示颈椎第7节水平有一肿块,在T1加权像上呈低信号,在T2加权像上周围呈低信号,内部信号混合。紧急手术切除了颈椎硬膜外肿块,随后的病理评估确诊为β2微球蛋白淀粉样瘤。血液透析相关淀粉样瘤通常在长期血液透析后出现,症状隐匿,非常罕见。本例表明,即使是血液透析病史短且症状迅速出现的患者,我们也需要意识到β2微球蛋白淀粉样瘤的可能性。