Davidson G S, Deck J H
Department of Pathology, Hospital for Sick Children, Toronto, Ontario, Canada.
Acta Neuropathol. 1988;77(1):104-8. doi: 10.1007/BF00688250.
Although the clinical findings in over 30 cases of delayed myelopathy after electrical injury have been described, there are scanty reports of the pathology of the spinal cord in such cases. We report a case in which progressive myelopathy presented 1 month after electrical injury by lightning strike and death occurred 4 months after injury. The spinal cord showed widespread demyelination of white matter from the medulla to just above the conus medullaris. This consisted of selective degeneration of myelin sheaths without inflammation or injury to axons, other cord components, or nerve roots. Infarction of more circumscribed segments of the thoracic cord where demyelination was greatest was probably due to edema associated with myelin degeneration, causing cord swelling limited by the pia mater. Raised pressure within the cord then resulted in secondary infarction.
虽然已有超过30例电损伤后迟发性脊髓病的临床病例报道，但此类病例中脊髓病理学的报告却很少。我们报告1例雷击伤后1个月出现进行性脊髓病，伤后4个月死亡的病例。脊髓显示从延髓到脊髓圆锥上方的白质广泛脱髓鞘。这表现为髓鞘的选择性变性，而无轴突、脊髓其他成分或神经根的炎症或损伤。胸段脊髓脱髓鞘最严重的局限性节段梗死，可能是由于与髓鞘变性相关的水肿，导致脊髓肿胀，硬脊膜限制了其肿胀程度。脊髓内压力升高进而导致继发性梗死。
