急性橫斷性脊髓病變合併亞急性出血之物理治療：個案報告

急性橫斷性脊髓病變(Acute Transverse Myelopathy)為一急性兩側性脊髓內病變症侯群，其臨床特徵為脊髓兩側性感覺及運動傳導路之病變，且常伴有直腸及膀胱功能之異常。本文病例為一20歲男性，其最初症狀為尿瀦留，經脊髓攝影及兩次磁振造影與注射對比劑檢查，發現T3-6有脊髓腫大及訊號增強之現象且合併亞急性出血，雖經大量類固醇治療，但病程仍迅速進行至兩下肢完全麻痺，經物理治療9個月後，運動及感覺功能慢慢恢復，現已可用兩側腋下拐杖行走及自我照顧，屬於預後尚可者。本文除報告其病程及磁振造影之變化外，亦與相關文獻作比較。

關鍵字

急性橫斷性脊髓病變；亞急性出血；物理治療

並列摘要

Acute transverse myelopathy (ATM) is an acute disorder characterized clinically by signs of lesions in motor and sensory tract on both sides of the spinal cord. Patient with a history of neurologic disease, or with evidence of lesion outside the spinal cord, are generally excluded from this diagnosis. The etiology of ATM include a periinfectious, postinfectious or vaccinal process, demyelination as part of multiple sclerosis, vascular insufficiency or malformation, and idiopathic or paracarcinomatous necrosis. The diagnostic criteria of ATM are 1) acutely developing (14 days or less) spinal cord lesion affecting motor and sensory system, 2) sphincter involvement, 3) well-definde spinal segmental level of sensory disturbances, 4) spinal cord compression excluded by myelography, 5) absence of other known neurological disease or underlying systemic disorder. Treatment is symptomatic, and the use of steroids has no demonstrated benefit in iodiopathic ATM. Approximately a third of patients will recover to good functional group with only mild urinary and minimal sensorimotor deficit, a third will became fair functional outcome which patients may be ambulatory with gait disturbance, urgency of micturition, constipation and obvious sensory signs, and a third will remain paralyzed with absence of sphincter control which is poor functional outcome. When improvement occurs, it is usually within 3 to 6 months. An early unfavorable prognosticator is the presence of spinal shock at the outset and severe back pain. Cerebrospinal fluid pleocytosis or protein elevations do not correlate with outcome. A 20-year-old male student with urine retention and progressive paraparesis was examined and diagnosed as a case of ATM. Myelography revealed normal which excluded extramedullary lesion. MRI (T1WI) showed increased signal intensity at bilateral T3-6 level (especially after contrast media injection) at the beginning of the course. Unfortunately, complete paraplegia developed in later days and MRI was done again which showed spinal cord swelling and subacute hemorrhage at T4-6 level on T1WI and T2WI. The patient received rehabilitation in following 9 months, with partial recovery of sensory and motor function which resulted in independent ADL and ambulation with bilateral axillary crutches, but urine retention persisted. Although he had two poor prognosis factors as spinal shock and back pain during the course, he made a fair recovery after rehabilitation. In reviewing the literature concerining ATM, the MRI finding of ATM includes local spinal cord enlargement and increased signal intensity, so this is the first case reported with subacute hemorrhage by the examination of MRI.

並列關鍵字

Acute Transverse Myelopathy ； Subacute Hemorrhage ； Physical Therapy

國際替代計量

急性橫斷性脊髓病變合併亞急性出血之物理治療：個案報告

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