Spinal Injuries, Southport and Ormskirk Hospital NHS Trust, Southport, UK
Radiology Department, Southport and Ormskirk Hospital NHS Trust, Southport, UK.
BMJ Case Rep. 2020 Dec 17;13(12):e238202. doi: 10.1136/bcr-2020-238202.
A 44-year-old male person with tetraplegia (C-5 AIS-A (American Spinal Cord Injury Association Standard Neurological Classification of Spinal Cord Injury Impairment Scale)) developed urinary tract infection and received appropriate antibiotic. Subsequently, he started sweating and shivering when he was sitting up; these symptoms resolved while lying on his back. Autonomic dysreflexia triggered by truncal movements continued to occur for 3 months. CT of the spine showed L5-S1 discitis. MRI of the spine showed diffuse marrow oedema in L5 and S1 vertebrae and a large abscess at L5/S1 level. Blood culture yielded sensitive to meropenem. Meropenem followed by ertapenem was given for 12 weeks. After 11 months, MRI showed resolution of discitis and epidural collection. The patient was able to sit up for 9 hours without developing autonomic dysreflexia. If a person with cervical spinal cord injury develops posture-related autonomic dysreflexia (eg, in sitting position, lying on sides or while hoisted), disco-vertebral pathology should be suspected.
一位 44 岁的男性四肢瘫痪患者（C-5 AIS-A（美国脊髓损伤协会脊髓损伤损伤程度分类标准））出现尿路感染，并接受了适当的抗生素治疗。随后，他在坐立时开始出汗和颤抖；这些症状在仰卧时缓解。躯干运动引发的自主反射异常持续了 3 个月。脊柱 CT 显示 L5-S1 椎间盘炎。脊柱 MRI 显示 L5 和 S1 椎体弥漫性骨髓水肿和 L5/S1 水平的大脓肿。血培养对美罗培南敏感。给予美罗培南 12 周后，换用厄他培南。11 个月后，MRI 显示椎间盘炎和硬膜外脓肿消退。患者能够坐 9 小时而不发生自主反射异常。如果颈脊髓损伤患者出现与姿势相关的自主反射异常（例如，在坐姿、侧卧或吊起时），应怀疑椎间盘-椎体病变。
