Yasui Hirotoshi, Ozawa Naoya, Mikami Satoshi, Shimizu Kenji, Hatta Takahiro, Makino Nami, Fukushima Mayu, Baba Satoshi, Makino Yasushi
Department of Respiratory Medicine, Chutoen Medical Center, Kakegawa, Shizuoka, Japan.
Department of Respiratory Medicine, Nagoya University Hospital, Nagoya, Aichi, Japan.
Am J Case Rep. 2017 Mar 17;18:276-280. doi: 10.12659/ajcr.902813.
BACKGROUND Spinal cord ischemia is an uncommon event that is mainly caused by dissociation of the ascending aorta as a complication after aortic surgery. Spinal arteries can develop collateral circulation; therefore, the frequency of spinal infarction is about 1% of that in the brain. Few cases of spinal cord ischemia developing in the course of lung cancer have been reported. CASE REPORT We presented the case of a 56-year-old man with small cell lung carcinoma, cT4N2M1a (stage IV). He was treated with irradiation and 2 courses of platinum and etoposide combination chemotherapy. He complained of back pain followed by quadriplegia and sensory disturbance after cessation of chemotherapy. With a diagnosis of spinal cord metastasis, steroids were administered. However, diaphragmatic paralysis appeared a few hours later. He was started on palliative care and died after 6 days. Autopsy showed epidural metastasis and spinal ischemia at the C5 level. CONCLUSIONS Epidural metastasis can compress the spinal artery and cause circulatory disorders. Spinal cord ischemia should be considered in patients with rapid paralysis in the course of lung cancer.
背景 脊髓缺血是一种罕见事件，主要由升主动脉夹层分离引起，为主动脉手术后的并发症。脊髓动脉可形成侧支循环；因此，脊髓梗死的发生率约为脑梗死的1%。肺癌病程中发生脊髓缺血的病例报道较少。病例报告 我们报告了一例56岁男性小细胞肺癌患者，cT4N2M1a（IV期）。他接受了放疗及2个疗程的铂类和依托泊苷联合化疗。化疗结束后，他主诉背痛，随后出现四肢瘫痪和感觉障碍。诊断为脊髓转移，给予类固醇治疗。然而，数小时后出现膈肌麻痹。他开始接受姑息治疗，6天后死亡。尸检显示C5水平硬膜外转移和脊髓缺血。结论 硬膜外转移可压迫脊髓动脉并导致循环障碍。肺癌病程中出现快速瘫痪的患者应考虑脊髓缺血。
