Bode H, Bubl R, Hefti F, Signer E, Wyler F
Universitäts-Kinderspital Basel.
Klin Padiatr. 1993 Sep-Oct;205(5):345-50. doi: 10.1055/s-2007-1025246.
23 children with acute spinal syndromes are presented. The clinical signs were caused by trauma in 11 patients, by extramedullary tumors in 6, by operations (coarctation of the aorta, scoliosis) in 4 and by encephalomyelitis in 2. Motor signs (flaccid paraplegia or paraparesis, monoplegia, bilateral weakness) and changes of reflex intensities were always observed. Most children presented with disturbances of sensory functions and micturition, some exhibited ataxia. In addition to the neurological signs, plain films of the spine were of diagnostic importance after trauma, for tumors myelography and/or computerized tomography were most useful. The unfavourable prognosis of posttraumatic paraplegia may be improved by early application of corticosteroids in very high doses. The value of GM1-ganglioside is controversial. In cases of external compression by tumors a decompression of the spinal cord is urgent. "Spinal cord monitoring" can be used intraoperatively in surgery of scoliosis and coarctation of the aorta to detect neurological complications early. Differential diagnosis and therapies of encephalomyelitis and Guillain-Barré-Syndrome are discussed.
本文报告了23例急性脊柱综合征患儿。临床症状由以下原因引起：11例为创伤，6例为髓外肿瘤，4例为手术（主动脉缩窄、脊柱侧凸），2例为脑脊髓炎。均观察到运动体征（弛缓性截瘫或轻截瘫、单瘫、双侧无力）和反射强度改变。大多数患儿有感觉功能和排尿障碍，部分患儿有共济失调。除神经体征外，创伤后脊柱平片具有诊断意义，对于肿瘤，脊髓造影和/或计算机断层扫描最为有用。早期应用大剂量皮质类固醇可改善创伤后截瘫的不良预后。GM1神经节苷脂的价值存在争议。对于肿瘤引起的外部压迫，紧急进行脊髓减压。“脊髓监测”可在脊柱侧凸和主动脉缩窄手术中用于早期发现神经并发症。本文还讨论了脑脊髓炎和吉兰-巴雷综合征的鉴别诊断及治疗。
