Spinal Epidural Hemorrhage Three Cases Report and Literature Review

脊椎硬腦膜外出血三病例報告及文獻回顧

賴慧貞(Huey-Jen Lay) ； 張權維(Chein-Wei Chang) ； 連倚南(I-Nan Lien)

《中華民國復健醫學會雜誌》 19期 (1991/12) Pp. 139-145

https://doi.org/10.6315/JRMA.199112.0139

摘要

脊椎硬腦膜外出血是一種少見的外科急症，它常被誤診或施以錯誤治療，而導致嚴重的脊髓損傷甚至死亡，文獻記載中約半數可找出致病因素，而以外傷及服用抗凝血藥物最常見；另外半數被歸為原發性出血。本文報告國立臺灣大學附設醫院的三個病例，其症狀由嚴重的突發性背痛開始，在數分鐘至數天之內進行至下肢癱瘓，第一例因早期診斷及減壓手術而有良好的恢復，第二例是低位胸椎的硬腦膜外出血，其早期的疼痛被誤診為腹部急症；伴隨而來的感覺缺損被視為疼痛改善，局部背痛及與皮神經感覺分佈區相符的傳導痛可定位脊椎病變，在疼痛減低時重覆感覺系統檢查亦可免於誤診，第三例在弛緩性下肢癱瘓後才有正確的診斷，然而錯採保守療法延誤了手術時機。硬腦膜外出血在脊椎有別於顱部，即其為絕對外科急症，醫療人員應瞭解此症並作緊急，適當的處置及復健。

並列摘要

Spinal epidure hemorrhage is rare. It is often misdiagnosed and mistreated, and may result in severe paraplegia or death. Abort half of the cases reported in the literature had identifiable causes. Among these, trauma and anticoagulant therapy were most frequently encountered. The others were known as spontaneous spinal epidural hemorrhage. We report here 3 cases treated in NTUH. Their symptoms included sudden onset of severe localized back pain and flaccid paralysis of lower extremities which progressed within minutes to days. In case 1, early spinal decompression minimized the possible neurological sequelae. In case 2, hematoma occurred in the lower thoracic spine. Pain in the early stage was not differenciated carefully from acute abdomen. Diagnosis was made in case 3 when flaccid paralysis developed completely. Unlike that occurs in the skull, epidural hemorrhage in the spine is always a surgical emergency. It is important to differentiate from other causes of spinal cord injury, and to make early diagnosis and management.

並列關鍵字

spinal ； epidural hemorrhage