Rua Adriana, Blanco Yolanda, Sepúlveda María, Sola-Valls Núria, Martínez-Hernández Eugenia, Llufriu Sara, Berenguer Joan, Graus Francesc, Saiz Albert
Hospital Clinic de Barcelona. Institut Clinic de Malalties del Sistema Nervios, 08036 Barcelona, Espana.
Rev Neurol. 2015 Dec 1;61(11):499-502.
INTRODUCTION: Spondylotic myelopathy is the commonest cause of nontraumatic myelopathy. Radiological features of spondylotic myelopathy can often overlap with inflammatory myelopathies which may lead to a delayed or incorrect diagnosis and therapy. A distinctive gadolinium enhancement pattern recently described may help to differentiate spondylotic from inflammatory myelopathy. CASE REPORTS: Case 1: a 38-years-old man presented with a 2-year history of paresthesias in the upper extremities, and one year later cramps on the right limbs and numbness over right C5 and C6 dermatomes, related to movement of the neck. Case 2: a 44-year-old man presented with a 1-year history of progressive gait difficulties and sensory disturbance in the hands, and a recent onset of bladder dysfunction. In both cases, spinal cord MRI identified a longitudinal cervical T2-signal hyperintensity associated with a pancakelike transverse band of gadolinium enhancement just below the site of maximum spinal stenosis, and circumferential or hemicord enhancement on axial images. CONCLUSIONS: The radiological features of spondylotic myelopathy may resemble those of inflammatory origin. The recognition of a transverse pancakelike gadolinium enhancement immediately below the site of maximal compression as a typical radiological pattern of spondylotic myelopathy is important to reduce the risk of misdiagnosis and to help in the management of these patients.
引言:脊髓型颈椎病是非创伤性脊髓病最常见的病因。脊髓型颈椎病的放射学特征常与炎症性脊髓病重叠,这可能导致诊断和治疗延迟或错误。最近描述的一种独特的钆增强模式可能有助于区分脊髓型颈椎病和炎症性脊髓病。 病例报告:病例1:一名38岁男性,有2年上肢感觉异常病史,1年后出现右下肢痉挛及右侧C5和C6皮节麻木,与颈部活动有关。病例2:一名44岁男性,有1年进行性步态困难和手部感觉障碍病史,近期出现膀胱功能障碍。在这两个病例中,脊髓MRI均显示颈段脊髓T2信号纵向增高,在脊髓狭窄最严重部位下方有一个薄饼样横向钆增强带,轴位图像上有环形或半脊髓增强。 结论:脊髓型颈椎病的放射学特征可能与炎症性起源的相似。认识到在最大压迫部位下方立即出现的薄饼样横向钆增强是脊髓型颈椎病的典型放射学模式,对于降低误诊风险和帮助管理这些患者很重要。
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