Da Silva L F, Robin S, Guégan-Massardier E, Krzanowska K, Mejjad O, Vittecoq O, Le Loet X
Rheumatology Department, Rouen Teaching Hospital, France.
Rev Rhum Engl Ed. 1997 Dec;64(12):839-42.
A 42-year-old male was admitted for right-sided sciatica with asymptomatic septic arthritis of the fifth toe of the right foot. He had a history of active chronic hepatitis C and septic arthritis of the fifth toe of the left foot. His symptoms included low back pain, poorly systematized right-sided sciatica, impairment of all forms of sensation in both lower limbs, absent ankle jerks, episodes of urinary retention, urgency, and painless septic arthritis of the fifth toe of the right foot. Roentgenograms showed a spina bifida occulta of L5 and a bony erosin in the distal interphalangeal joint of the right fifth toe. Distal denervation in the territory of L5 was demonstrated by the electromyographic study. Magnetic resonance imaging disclosed an area of high signal on T1 and T2 images, located within the spinal canal opposite L4 and suggestive of an intraspinal lipoma, as well as tethering of the spinal cord in an abnormally distal position. Antimicrobial therapy was effective in ensuring resolution of the infectious arthritis. The low back pain and sciatica responded to nonsteroidal antiinflammatory drug therapy and did not recur subsequently. Many patients who have roentgenograms taken to evaluate low back pain and sciatica are found to have a spina bifida occulta. This complex birth defect involving the spinal canal, meninges and spinal cord or cauda equina can cause neurologic and/or urinary symptoms in adulthood. Magnetic resonance imaging is essential in this situation to evaluate the spinal cord and to look for an intraspinal lipoma.
一名42岁男性因右侧坐骨神经痛入院，其右足第五趾存在无症状性化脓性关节炎。他有活动性慢性丙型肝炎病史及左足第五趾化脓性关节炎病史。他的症状包括腰痛、右侧坐骨神经痛但症状不典型、双下肢各种感觉减退、踝反射消失、尿潴留发作、尿急以及右足第五趾无痛性化脓性关节炎。X线片显示L5隐性脊柱裂及右足第五趾远侧指间关节骨质侵蚀。肌电图检查显示L5区域存在远端去神经支配。磁共振成像显示在T1和T2图像上有一个高信号区域，位于L4水平对应的椎管内，提示椎管内脂肪瘤，以及脊髓在异常低位被牵拉。抗菌治疗有效确保了感染性关节炎的消退。腰痛和坐骨神经痛对非甾体抗炎药治疗有反应，且随后未再复发。许多因腰痛和坐骨神经痛而进行X线检查的患者被发现有隐性脊柱裂。这种涉及椎管、脑膜和脊髓或马尾的复杂先天性缺陷可在成年期引起神经和/或泌尿系统症状。在这种情况下，磁共振成像对于评估脊髓和寻找椎管内脂肪瘤至关重要。
