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儿童急性横贯性脊髓炎并发继发性脊柱侧弯

Secondary Scoliosis as a Complication of Acute Transverse Myelitis in a Child.

作者信息

D'Amico Silvia, Pavone Piero, Testa Gianluca, Greco Filippo, Marino Lidia, Smilari Pierluigi, Pavone Vito

机构信息

Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy.

Department of Orthopaedics and Traumatologic Surgery, AOU Policlinico-Vittorio Emanuele, University of Catania, Via Santa Sofia, 78, 95123 Catania, Italy.

出版信息

J Funct Morphol Kinesiol. 2020 Jun 9;5(2):39. doi: 10.3390/jfmk5020039.

Abstract

Acute transverse myelitis (ATM) is a rare neurological condition that affects the spinal cord. Several events, including infections, autoimmune conditions, inflammatory, and drug-induced factors, may cause this disorder. Correct and rapid etiological diagnosis is necessary in order to start appropriate treatment that mainly consists of immunomodulating therapy, high dose intravenous corticosteroids, and in plasma exchange in noninfectious cases. The outcome is varied and depends on several factors. In children, the prognosis is usually good. We report a case of an 11-year-old boy who presented with interscapular pain, right leg steppage, homolateral hyposthenia of the upper limb, and signs of autonomic dysfunction. After performing specific and instrumental exams, a diagnosis of transverse myelitis was reached, and appropriate therapy was performed. A few days post-treatment, the child developed a secondary scoliosis, involving a thoracolumbar curve with loss of cervical and lumbar lordosis. After rehabilitative treatment was undertaken for 12 months, a complete recovery and normal restoration of spinal physiological curves was obtained. The pediatric cases of ATM have a good response to steroid therapy combined with physiotherapy. Collaboration among the various specialists is worthwhile, in order to lead to a correct and rapid diagnosis.

摘要

急性横贯性脊髓炎(ATM)是一种影响脊髓的罕见神经系统疾病。包括感染、自身免疫性疾病、炎症和药物诱导因素在内的多种情况可能导致这种疾病。为了开始主要包括免疫调节治疗、大剂量静脉注射皮质类固醇以及非感染性病例中的血浆置换的适当治疗,正确且快速的病因诊断是必要的。其结果各不相同,取决于多种因素。在儿童中,预后通常良好。我们报告一例11岁男孩病例,该男孩表现为肩胛间疼痛、右腿划圈步态、上肢同侧肌力减退以及自主神经功能障碍体征。在进行了特定检查和器械检查后,确诊为横贯性脊髓炎,并进行了适当治疗。治疗几天后,该儿童出现继发性脊柱侧弯,累及胸腰段曲线,颈椎和腰椎前凸消失。经过12个月的康复治疗后,实现了完全康复,脊柱生理曲线恢复正常。ATM的儿科病例对类固醇治疗联合物理治疗反应良好。为了实现正确且快速的诊断,各专科医生之间的协作是值得的。

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本文引用的文献

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Pediatric acute transverse myelitis.小儿急性横贯性脊髓炎
Neurosciences (Riyadh). 2017 Jul;22(3):233-234. doi: 10.17712/nsj.2017.3.20170294.
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Pediatric transverse myelitis.小儿横贯性脊髓炎
Neurology. 2016 Aug 30;87(9 Suppl 2):S46-52. doi: 10.1212/WNL.0000000000002820.
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Pediatric acute transverse myelitis overview and differential diagnosis.小儿急性横贯性脊髓炎概述与鉴别诊断
J Child Neurol. 2012 Nov;27(11):1426-36. doi: 10.1177/0883073812452916. Epub 2012 Aug 21.

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