Suksathien Rachawan, Kunadison Salintip, Wongfukiat Oragarn, Ingkasuthi Kanlaya
J Med Assoc Thai. 2016 Dec;99(12):1367-71.
Spinal gnathostomiasis results in serious multiorgan impairments. Magnetic resonance imaging (MRI) and serology help in diagnosis, and assessing the severity and extent of the disease. However, the physiology of neural pathway could not be demonstrated. Electrodiagnosis may have a role in demonstrating the functions of the central and peripheral neural pathways and prognostic assessment of the disease.
An 18-year-old man presented with radicular pain and rapid progressive weakness of lower extremities, leading to paraplegia in three days. A clinical evaluation and laboratory tests, including serology, MRI, and electrodiagnosis, were performed.
The investigation showed L1 paraplegia with urinary retention. The serial MRI of T-spine showed longitudinal T2 hypointense lesion along the lower thoracic spinal cord, representing track-like hemorrhage with spinal cord edema at the onset of symptoms, nodular enhancement of T11-T12 spinal cord, and enhancing and clumping of cauda equina nerve roots in the MRI at two months after the first MRI. The CSF and serum for Gnathostoma antibody were positive. Intravenous corticosteroid and oral albendazole were given. Three months after treatment, the symptoms improved in sensation but not in motor function. The electrodiagnosis was performed. There were very small amplitudes and no response in bilateral tibial and peroneal motor nerve conduction studies (NCS) respectively. The bilateral sural sensory NCS were normal. Neither tibial somato-sensory evoke potentials (SSEP) nor motor evoke potential (MEP) was recorded. No further improvement of patient’s clinical status at eight months after onset was observed.
Electrophysiological findings demonstrated the function of spinal cord and peripheral nerves in the patient with spinal gnathostomiasis. There were correlations between MRI and electrophysiological findings that confirmed pathophysiology of the disease. Absence of SSEP and MEP response correlated with poor neurological outcomes in radiculomyelitis caused by Gnathostoma spp. infection.
脊髓颚口线虫病会导致严重的多器官损害。磁共振成像（MRI）和血清学有助于诊断，并评估疾病的严重程度和范围。然而，神经通路的生理学情况无法得到证实。电诊断可能在显示中枢和周围神经通路的功能以及疾病的预后评估方面发挥作用。
一名18岁男性出现神经根性疼痛和下肢迅速进行性无力，三天内发展为截瘫。进行了临床评估和实验室检查，包括血清学、MRI和电诊断。
检查显示L1水平截瘫并伴有尿潴留。胸椎的系列MRI显示下胸段脊髓沿纵向T2低信号病变，代表症状发作时的条索状出血伴脊髓水肿，T11 - T12脊髓结节状强化，以及首次MRI检查两个月后的MRI中马尾神经根强化和聚集。脑脊液和血清中的颚口线虫抗体呈阳性。给予静脉注射皮质类固醇和口服阿苯达唑。治疗三个月后，感觉症状有所改善，但运动功能未改善。进行了电诊断。双侧胫神经和腓总神经运动神经传导研究（NCS）的波幅非常小且分别无反应。双侧腓肠神经感觉NCS正常。未记录到胫神经体感诱发电位（SSEP）和运动诱发电位（MEP）。发病八个月后未观察到患者临床状况的进一步改善。
电生理结果显示了脊髓颚口线虫病患者脊髓和周围神经的功能。MRI和电生理结果之间存在相关性，证实了疾病的病理生理学。SSEP和MEP反应缺失与颚口线虫属感染引起的神经根脊髓炎的不良神经学预后相关。
