Fanous Andrew A, Olszewski Nathan P, Lipinski Lindsay J, Qiu Jingxin, Fabiano Andrew J
Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.
Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.
Case Rep Pathol. 2016;2016:8706062. doi: 10.1155/2016/8706062. Epub 2016 Sep 8.
The differential diagnoses for spinal cord lesions include spinal tumors and inflammatory processes. The distinction between these pathologies can be difficult if solely based on imaging. We report for the first time to our knowledge a case of idiopathic transverse myelitis (ITM) mimicking a discrete cervical spinal lesion in a 66-year-old man who presented with gait instability and neck pain. The patient's symptoms failed to resolve after an initial course of steroid therapy. Surgical biopsy confirmed the diagnosis of ITM. Subsequent treatment with dexamethasone resulted in complete resolution of the symptoms as well as the intramedullary enhancement. ITM is most common in the cervical and thoracic spine, spanning 3-4 spinal segments. It usually occupies more than 50% of the cross-sectional area of the spinal cord and tends to be central, uniform, and symmetric. It exhibits patchy and peripheral contrast enhancement. These criteria are useful guidelines that help distinguish ITM from neoplastic spinal lesions. A decision to perform biopsy must take into consideration the patient's clinical symptoms, the rate of progression of neurological deficits, and the imaging characteristics of the lesion. Surgical biopsy for questionable lesions should be reserved for patients with progressive neurological deficits refractory to empirical medical therapy.
脊髓病变的鉴别诊断包括脊髓肿瘤和炎症性疾病。如果仅基于影像学检查，区分这些病变可能会很困难。据我们所知，我们首次报告了一例66岁男性特发性横贯性脊髓炎（ITM），其表现为步态不稳和颈部疼痛，影像学上酷似离散的颈段脊髓病变。患者在初始类固醇治疗疗程后症状未缓解。手术活检确诊为ITM。随后用地塞米松治疗使症状以及髓内强化完全消退。ITM最常见于颈段和胸段脊柱，累及3 - 4个脊髓节段。它通常占据脊髓横截面积的50%以上，且倾向于位于中央、均匀且对称。它表现为斑片状和周边对比增强。这些标准是有助于将ITM与脊髓肿瘤性病变区分开来的有用指南。决定进行活检必须考虑患者的临床症状、神经功能缺损的进展速度以及病变的影像学特征。对于可疑病变的手术活检应仅用于对经验性药物治疗难治的进行性神经功能缺损患者。
