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Acute Transverse Myelitis Presenting with Vertigo


急性橫斷性脊髓炎(acute transverse myelitis)是一種神經科的疾病,往往會有兩側性的運動、感覺和自主神經系統的障礙,合併眩暈為起始症狀者相當罕見。一50歲女性,因為眩暈、前額頭痛、視力模糊、噁心、嘔吐及兩側下肢無力而求診,於低血鉀矯正後,兩側下肢無力依然持續,並發生胸部以下感覺缺損及排尿困難等現象,視運動性眼振檢查顯示兩側波形障礙,腦脊液檢查正常,血液學檢查顯示抗核酸抗體及血清IgG指數偏高,顯影劑增強磁振造影顯示頸段脊髓腫大且略為顯影,並無腦幹或視神經的病灶,診斷為急性橫斷性脊髓炎,給予靜脈注射類固醇後症狀逐漸緩解。出院1週後的磁振造影顯示頸段脊髓已經消腫。大多數的病患只經歷單次的疾病,少數會復發,未來幾10年仍需追蹤,注意是否會演變為多發性硬化症(multiple sclerosis)。

Parallel abstracts

Acute transverse myelitis is a neurological disease. Bilateral motor, sensory and autonomic symptoms are common, but vertigo is rarely seen. A 50-year-old female patient presented with persistent vertigo, a frontal headache, blurred vision, nausea, vomiting and lower limb weakness. Sensory impairment and urinary dysfunction also had developed, and paraparesis persisted after the hypokalemia was corrected during hospitalization. An optokinetic nystagmus test showed bilateral sick waves and at the same time a cerebrospinal fluid analysis was normal. A blood examination disclosed borderline anti-nuclear antibodies and an elevated serum IgG level. Her cervical spinal cord showed mild swelling and contrast-enhancement when examined by magnetic resonance imaging (MRI). Neither a brain stem nor an optic nerve's lesion was found. Based on the above, acute transverse myelitis was diagnosed. All the symptoms present in the patient relieved gradually after 5-days of pulsed intravenous methylprednisolone therapy. A week after discharged, her cervical spinal cord appeared to be normal by MRI. Most patients with this disease have a monophasic course, but a minority may have a recurrence. A diagnosis of multiple sclerosis should be considered if further neurological signs develop.