Schmidt Bradley T, Strayer Andrea L, Stadler James A
Neurosurgery, University of Wisconsin School of Medicine and Public Health, Madison, USA.
Cureus. 2020 Aug 19;12(8):e9870. doi: 10.7759/cureus.9870.
Development of synovial cysts in the rigid thoracic spine is rare. Additionally, synovial cysts with compression of nerve roots typically cause subacute or chronic radiculopathy. We present a patient who had a new diagnosis of upper thoracic (T1-2) synovial cyst that caused acute paraplegia while hospitalized for therapies and surgical planning. The patient is a 56-year-old male with a history of congestive heart failure secondary to alcoholic cardiomyopathy. He presented with a progressive bilateral lower extremity discoordination, urinary incontinence, and altered perineal sensation. His examination revealed intact strength to bedside assessment, intact rectal tone, but upgoing toes on Babinski testing. Given concern for myelopathy, MRI thoracic spine was obtained and demonstrated large T1-2 synovial cyst causing severe compression with associated T2 signal change within the spinal cord. He underwent expedited cardiac optimization that included resumption of outpatient antihypertensive medications and the addition of a single dose of intravenous diuretic. The patient had subsequent transient hypotension following significant diuresis and developed acute paraplegia in his bilateral lower extremities. Fluids and vasopressors were initiated, and he underwent emergent surgery for decompression and synovial cyst resection. The patient did very well and had normalization of his neurological exam within 24 hours. We present a case of acute paraplegia secondary to hypotension and spinal cord hypoperfusion in a patient with upper thoracic synovial cyst. This is rare pathology with an even more unique presentation. The authors recommend careful perioperative hemodynamic monitoring to help avoid acute worsening in this patient population.
僵硬胸椎部位滑膜囊肿的形成较为罕见。此外，伴有神经根受压的滑膜囊肿通常会引发亚急性或慢性神经根病。我们报告一例患者，该患者新诊断为上胸椎（T1 - 2）滑膜囊肿，在住院接受治疗和手术规划期间导致急性截瘫。患者为一名56岁男性，有酒精性心肌病继发充血性心力衰竭病史。他表现为进行性双侧下肢共济失调、尿失禁及会阴部感觉改变。体格检查显示床边评估时肌力正常、直肠张力正常，但巴宾斯基征检查时脚趾背屈。鉴于怀疑存在脊髓病，遂行胸椎磁共振成像（MRI）检查，结果显示T1 - 2水平有一个大的滑膜囊肿，造成严重压迫，脊髓内伴有T2信号改变。他接受了快速心脏功能优化治疗，包括恢复门诊使用的抗高血压药物，并加用一剂静脉利尿剂。患者在大量利尿后出现短暂性低血压，随后双侧下肢发生急性截瘫。开始给予补液和血管加压药治疗，并对其进行了紧急减压及滑膜囊肿切除术。患者恢复良好，24小时内神经学检查结果恢复正常。我们报告一例上胸椎滑膜囊肿患者因低血压和脊髓低灌注继发急性截瘫的病例。这是一种罕见的病理情况，其表现更为独特。作者建议在围手术期进行仔细的血流动力学监测，以帮助避免该患者群体病情急性恶化。
