脊髓腫瘤－診斷腦中風之陷阱：病例報告

Spinal Tumor-Pitfall in Diagnosis of CVA: Case Report

盧俊良(June-Liang Lu) ； 王錦基(Giin-Gi Wang) ； 薛澤杰(Tse-Chieh Hseuh)

《中華民國復健醫學會雜誌》 21期 (1993/12) Pp. 145-148

摘要

脊髓腫瘤最常見的臨床症狀，雖然為全身疼痛，但是由於腫瘤壓迫所造成的腦壓上升，以及所伴隨的漸進性肢體無力，常造成臨床醫師在診斷上的混淆。本文報告一位半側肢體無力和全身痠痛的病患，初期診斷為腦血管梗塞和水腦症。經過半年腦室引流和藥物治療之後，並無明顯改善。反而有雙側肢體無力，張力增強的進行性病程。經過重新評估檢查後，發現為頸髓內髓鞘瘤。由於半側肢體無力在老年人最常見的病因為腦中風，但當發現合併有腦壓上升或是雙側肢體無力時，脊髓腫瘤亦需列入鑑別診斷。本文特別提出此一病例，以供各位復健科醫師參考。

並列摘要

It has been reported that neurilemomas comprise approximately 30% of primary intraspinal neoplasms. Spinal cord tumors, sometimes without spinal symptoms, occasionally cause signs and symptoms of intracranial disease in the form of papilledema and/or hydrocephalus.
The association of hydrocephalus with benign extramedullary spinal cord tumors is particularly rare. The incidence was only 1% to 3%. So, in the diagnosis of intraspinal tumor, the associated presentations of intracranial hypertension were as important as hydrocephalus. Especially, when some of these signs and symptoms were noted in the elderly, intraspinal lesion should also be taken into consideration in addition to the most common cause of stroke.
We described a patient, a 70-year-old woman, who noted the onset of progressive soreness and weakness in her right limbs in October 1991. Cerebral lacumar infarct with right hemiparesis was diagnosed intially by neurlolgist in December 1991. Hydrocephalus was found in the brain CT scan. Ventroperitoneal shunting was done by beurosurgeon. After discharge, the weakness and hypertonicity slowly progressed and extended to the left side extremities.
Under the suspicion of cervical myelopathy, we discovered a C3-4 dumbbell-shaped nodular mass by cervical myelography and CT scan. Surgical resection was done and the pathology revealed neurilemoma.

並列關鍵字

Spinal cord tumor ； cerebral infarct ； hydrocephalus.