Schlüter E, Heuser K
Department of Pathology, University of Kiel, Germany.
Virchows Arch. 1998 Nov;433(5):487-91. doi: 10.1007/s004280050278.
A healthy 16-year-old male suddenly developed paraesthesiae in his hands during heavy manual labour. He was able to walk to the nearest doctor's practice himself. The symptoms worsened dramatically, and within a short period of time cardiac arrest occurred. After resuscitation and intensive care, quadriplegia due to a high cervical cord lesion was diagnosed. The patient died 70 days later without any changes in the neurological symptoms. Post mortem revealed severe focal ischaemic lesions in the cervical spinal cord in a mixed arterial/venous distribution, but no evidence of direct traumatic changes in the spinal cord, the spine or the soft tissues. All other possible causes than trauma were excluded. The clinical development of the symptoms suggest that this spinal cord lesion should be classified as a secondary traumatic spinal cord injury caused by a subluxation of the cervical spine. The pathogenesis of post-traumatic ischaemic damage to the spinal cord appears to be related to localized hypercoagulability resulting in the formation of microthrombi. Impaired microcirculation in a limited area and for a limited period of time may have caused the irregularly distributed ischaemic necrosis.
一名健康的16岁男性在繁重体力劳动期间突然双手出现感觉异常。他自行步行至最近的诊所。症状急剧恶化，短时间内发生心脏骤停。经复苏和重症监护后，诊断为高位颈髓损伤所致四肢瘫痪。患者70天后死亡，神经症状无任何变化。尸检显示颈髓有严重的局灶性缺血性病变，呈动静脉混合分布，但脊髓、脊柱或软组织无直接创伤性改变的证据。排除了创伤以外的所有其他可能原因。症状的临床发展表明，这种脊髓损伤应归类为由颈椎半脱位引起的继发性创伤性脊髓损伤。创伤后脊髓缺血性损伤的发病机制似乎与局部高凝状态导致微血栓形成有关。有限区域内和有限时间内的微循环障碍可能导致了缺血性坏死的不规则分布。
