兒童自發性脊髓硬膜外血腫：病例報告

Pediatric Spontaneous Spinal Epidural Hematoma: A Case Report

李棟洲(Tung-Chou Li) ； 許美慧(Mei-Hue Hsu)

《中華民國復健醫學會雜誌》 30卷1期 (2002/03) Pp. 33-39

https://doi.org/10.6315/JRMA.200203.0033

摘要

自發性脊髓硬膜外血腫（spontaneous spinal epidural hematoma，SSEH） 是指非外傷性、意外、醫源性（如腰椎穿刺）等原因所產生的脊髓硬膜外出血。它是一個造成脊髓壓迫的罕見原因，可能造成嚴重的神經功能永久性的喪失。SSEH在各年齡層均可能發生，過去的文獻報告顯示大部份的病例多發生在40-50歲之後，兒童發生的比率較少。在此我們報告一位以急性腹痛為初始症狀的5歲女童，於二天後出現下肢無力時才以脊髓核磁共振造影診斷出胸髓硬膜外出血，在經過緊急減壓手術及復健治療後，除下肢反射輕微增加外，其他神經功能完全恢復正常。因係罕見病例且早期診治對於病患日後功能的恢復影響很大，希望藉由此病例報告做為臨床醫師日後處理類似疾病的參考。

關鍵字

自發性脊髓硬膜外出血 ； 減壓手術 ； 椎板切除

並列摘要

Spontaneous spinal epidural hematoma is a rare disease and may result in permanent neurological damages. The main causes include anticoagulant therapy, vascular anomalies, hypertension, blood dyscrasias, drug abuse, neoplasm, iatrogenic epidural anesthesia or rarely spinal surgery. Spontaneous spinal epidural hematoma generally occurs in adults between ages of 40 to 50 and rarely appears in children. We reported a 5-year-old girl who was admitted with severe acute abdominal pain as the initial chief complaint. Two days after admission, the patient had bilateral legs weakness progressively; then a thoracic spine epidural hematoma was diagnosed by spinal magnetic resonance imaging examination. After emergency decompressive operation and postoperative rehabilitation, the patient had good neurological and functional recovery. Although a new epidural hematoma at the same spinal level was noted in the follow up magnetic resonance imaging 3 months later, the patient didn't have any neurological deterioration. Because this disease is rare and early diagnosis and treatment are very important for patient's functional outcome, we would like to report this case for your reference.

並列關鍵字

spontaneous spinal epidural hematoma ； decompression operation ； laminectomy