脊椎腔內硬膜上血腫：病例報告

Spinal Epidural Hematoma: Cases Report

沈戊忠(Wu-Chung Shen) ； 陳啟昌(Chi-Chung Chen) ； 詹益豐(Yick-Fung Jim) ； 陳昭安(Chao-An Chen)

《中華放射線醫學雜誌》 22卷4期 (1997/08) Pp. 181-184

摘要

脊椎腔內的硬膜上血腫是一種罕見的疾病，常會導致病患嚴重的神經症狀，必須及時診斷並考慮緊急外科手術治療，而放射科醫師的正確診斷扮演很重要的角色。診斷脊椎的硬膜上血腫以MRI為最方便及最正確，但對於無法做MRI檢查的患者，傳統的脊髓造影及CT仍相當重要。本文報告三例脊椎硬膜上血腫。其中二例做了MRI檢查，MRI可以很清楚地顯示病灶及其對脊髓的壓迫。CT影像不如MRI清楚。有二例做了脊髓造影，雖然這些硬膜上血腫很大、很長，做脊髓造影時，水溶性顯影劑卻可流過病灶區，不像腫瘤會引起顯影劑完全阻塞。我們認為這種脊髓造影檢查所見值得供診斷的參考。

關鍵字

腦脊髓膜，出血 ； 脊髓造影 ； 電腦斷層攝影 ； 脊椎，出血 ； 磁振造影

並列摘要

Spontaneous spinal epidural hematoma is a rare but urgent condition, which rapidly induces sensory, then motor deficits. Therefore early diagnosis and emergent operation for removal of the hematoma is mandatory to prevent irreversible change of spinal cord compression. Radiologists play an important role in making an immediate and correct diagnosis by MRI, myelography or CT. MRI has been proved to be the most useful diagnostic tool for the diagnosis of spinal epidural hematoma. However, MR examination is impossible in some situations, such as, in patients with pacemakers or spinal rod fixations.
In this article, we report three cases of spinal epidural hematomas. Two cases occurred in the thoraco-lumbar levels and received emergent surgical evacuation. One case in the cervical spine where the hematoma resolved spontaneously. The spinal EDHs were clearly depicted by MRI, but less easily be detected by CT. One patient had a spinal rod fixation, so MRI was not indicated. Two cases received myelography using water-soluble contrast medium. We found the water soluble contrast medium could flow through the hematoma region smoothly without significant obstruction, as oppossed to the complete obstruction that might occur where other lesions such as tumor, abscess or HIVD were present. We believe this is an important indication for the diagnosis of spinal epidural hematoma.

並列關鍵字

Meninges, hemorrhage ； Myelography ； Spine, CT ； Spine ； hemorrhage ； Spine, MR