頸部硬膜內神經鞘瘤以非尋常對側上肢下運動神經元病變為臨床表徵之病例報告

一位二十四歲男性，自覺左上臂因負荷重物後，逐漸肌肉萎縮及無力，曾至多家醫院求診，一直被認為臂神經叢神經病變，而接受復健治療，但症狀仍持續惡化，後轉本院求診，經神經學檢查，感覺系統無異常，但運動系統如左側三角肌、肱二頭肌、肱三頭肌、臂橈肌及胸肌有明顯的萎縮及肌力減低，同時無明顯的錐體壓迫症候。電生理學檢查發現神經傳導速度包括運動及感覺神經均正常，但兩上肢正中神經及尺神經F波（F-wave）有明顯的延長現象，故進一步脊髓攝影合併電腦斷層檢查，發現右後側頸部脊髓C3-7有一啞鈴形腫塊擠壓脊髓至左側，經外科切除，病理報告為神經鞘瘤（Neurilemoma），這種大的頸椎硬膜內神經鞘瘤僅出現對側上肢下運動神經元症狀的臨床表徵，在臨床上極為少見，若不謹慎易造成誤診，而延誤治療，又脊髓攝影合併電腦斷層掃描為極重要的診斷工具。

關鍵字

頸部硬膜內神經鞘瘤；對側下運動神經元病變

並列摘要

A young adult man, who suffered from progressive muscle wasting and weakness over left arm for 5 months. Left brachioplexus neuropathy and motor neuron disase were suspected in some other hospitals under nerve conduction and electromyography survey. Rehabilitation was performed for three months, but in vain. Then he visited our hospital on Dec. 24'88. The neurologic examination showed muscle atrophy & weakness over left deltoid, biceps; triceps brachioradialis and pectoris major. The deep tendon reflex including biceps, triceps and brachioradialis revealed decrease. There were no definite sensory deficits and cord compression sign. NCV study revealed normal distal latency and normal conductive velocity both in sensory and motor study, but prolongation of F-wave was noted at meidan nerve and ulnar nerve. EMG study revealed denervation sign over bilateral sides of deltoid, biceps, triceps and brachioradialis, Cervical myelography with CT scan showed right posterial intradural and extramedullary mass from C3 to C7 levels. Tumor was removed and revealed a picture of neurilemoma. This case is believed to be rare in which a big intradural neurilemoma in the cervical region present only the contralateral lower motor neuron disease.

並列關鍵字

Intraduaral neurilemoma ； Contralateral lower motor neuron disease

國際替代計量

頸部硬膜內神經鞘瘤以非尋常對側上肢下運動神經元病變為臨床表徵之病例報告

全文下載

主題瀏覽