长期接受皮质类固醇治疗的神经结节病患者发生脊髓出血：病例报告
Spinal cord hemorrhage in a patient with neurosarcoidosis on long-term corticosteroid therapy: case report.
作者信息
Pegat Benoit, Drapier Sophie, Morandi Xavier, Edan Gilles
机构信息
Department of Neurology, Pontchaillou Hospital, Rennes University Hospital, Rennes, France.
Department of Neurosurgery, Pontchaillou Hospital, Rennes University Hospital, Rennes, France.
出版信息
BMC Neurol. 2015 Jul 30;15:123. doi: 10.1186/s12883-015-0373-6.
BACKGROUND
Central nervous system bleeding is a rare complication of neurosarcoidosis: only 18 cases of spontaneous cerebral hematoma have been reported. We present the first recorded case of spinal cord hemorrhage in neurosarcoidosis.
CASE PRESENTATION
A 48-year-old Caucasian woman had relapsing neurosarcoidosis for 5 years, with inflammatory spinal and cerebral lesions. While on 20 mg corticosteroids, she experienced subacute paraparesia with right leg pain. A spine MRI revealed a low thoracic hematomyelia at the T10-T11 level. Despite high doses of corticosteroids, her condition continued to worsen. Surgical evacuation of the hematoma was performed 10 days after the onset of bleeding, and she partially recovered.
CONCLUSION
This report highlights the possibility of spinal cord hemorrhage secondary to sarcoid vasculitis. The patient improved after surgical evacuation of the intramedullary hematoma. Immuno-modulating agents must be envisaged in severe neurosarcoidosis, to prevent complications.
背景
中枢神经系统出血是神经结节病的一种罕见并发症：仅报告了18例自发性脑血肿病例。我们报告了首例有记录的神经结节病脊髓出血病例。
病例介绍
一名48岁的白种女性患有复发性神经结节病5年，有脊柱和脑部炎症性病变。在服用20毫克皮质类固醇期间，她出现亚急性下肢轻瘫并伴有右腿疼痛。脊柱磁共振成像显示在T10 - T11水平有胸段脊髓血肿。尽管使用了高剂量皮质类固醇，她的病情仍继续恶化。出血发作10天后进行了血肿手术清除，她部分康复。
结论
本报告强调了结节状血管炎继发脊髓出血的可能性。髓内血肿手术清除后患者病情改善。对于严重的神经结节病，必须考虑使用免疫调节剂以预防并发症。
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