Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Health Services and Clinical Care Research Group, Swiss Paraplegic Research, Nottwil, Switzerland.
Spinal Cord Ser Cases. 2023 Apr 7;9(1):14. doi: 10.1038/s41394-023-00572-8.
Postural hypotension (PH) is common in patients with spinal cord injury (SCI), especially those with tetraplegia. To effectively treat PH, identifying and eliminating treatable predisposing factors of PH are prerequisites before applying any interventions.
We report a patient with post-acute cervical SCI who suffered from intractable PH resulting from pseudomeningocele causing unfavorable rehabilitation outcomes. A previously healthy 34-year-old man with complete C6 SCI resulting from C6-C7 fracture dislocation developed PH in the first week of the rehabilitation program. No specific predisposing factors including anemia, hyponatremia, and dehydration were identified. Non-pharmacological interventions and pharmacological treatment were administered to the patient without satisfactory result, causing a delay in rehabilitation progression. In the fourth week of rehabilitation program, a mass at the surgical site was detected. A cervical MRI revealed a large fluid collection at the posterior aspect of cervical spines with a size of 7.9 × 6.8 × 5.0 cm. A diagnosis of pseudomeningocele was made and surgical site debridement with closing dura by grafting was immediately conducted. One day after surgery, PH disappeared, and the patient could progress in his rehabilitation program and achieve his short-term goal within three weeks.
Pseudomeningocele could be one of the precipitating factors of PH in patients with tetraplegia. Healthcare providers should consider investigating pseudomeningocele in patients who have intractable and unexplainable PH.
体位性低血压（PH）在脊髓损伤（SCI）患者中很常见，尤其是四肢瘫痪患者。为了有效治疗 PH，在应用任何干预措施之前，识别和消除可治疗的 PH 诱发因素是前提。
我们报告了一例急性颈段 SCI 后患者，因假性脑脊膜膨出导致难治性 PH，影响康复预后。一位 34 岁的健康男性，因 C6-C7 骨折脱位导致完全性 C6 节段 SCI，在康复计划的第一周出现 PH。未发现贫血、低钠血症和脱水等特定的诱发因素。虽然对患者进行了非药物和药物干预，但效果不佳，导致康复进展延迟。在康复计划的第四周，发现手术部位有一个肿块。颈椎 MRI 显示颈椎后部有一个 7.9×6.8×5.0cm 的大液体积聚。诊断为假性脑脊膜膨出，立即进行手术清创和硬脑膜修补。术后一天，PH 消失，患者可以在康复计划中继续进步，并在三周内实现短期目标。
假性脑脊膜膨出可能是四肢瘫痪患者 PH 的诱发因素之一。医护人员应考虑对难治性和不明原因的 PH 患者进行假性脑脊膜膨出的检查。
