急性自發性頸椎硬腦膜外血腫致右側肢體無力：病例報告

自發性脊椎硬腦膜外血腫(spontaneous spinal epidural hematoma)爲一少見疾病，其主要表現爲急性單側神經根疼痛，相對應的皮節感覺異常，單側肢體無力或雙下肢無力，以及排尿功能異常。其中急性發生的單側肢體無力必須與腦血管疾病、腫瘤、感染、動靜脈血管畸形、血管瘤或自體免疫疾病等原因共同作鑑別診斷。本篇報告一位42歲男性，在2006年9月某日下午，由於頸痛及右側無力來醫院急診。因腦部電腦斷層未發現出血，初步診斷爲梗塞性腦中風後住院，因神經功能惡化，再施以核磁共振檢查才顯示爲頸髓硬腦膜外血腫。病人經緊急減壓手術清除血塊，再加上持續復健治療之後，神經功能及日常生活功能均恢復良好。由於自發性脊椎硬腦膜外血腫症狀可能類似急性頸椎椎間盤破裂、硬腦膜外腫瘤、橫斷性脊髓炎、腦中風、心臟缺血、主動脈剝離、先天囊腫、脊椎炎、或感染如硬腦膜上膿瘍，故須一一加以鑑別診斷。本疾病若未能早期診斷，可能導致病人神經功能永久受損，嚴重者甚至造成死亡。本文提供醫護人員在照顧類似病例時，能早期診斷，適當處置，判斷預後及完整的復健治療。

關鍵字

自發性脊椎硬腦膜外血腫；急性脊髓病變；腦中風；頸椎；硬腦膜血腫；輕癱

並列摘要

Spontaneous spinal epidural hematoma is a rare disease. The cardinal presentations include acute unilateral radicular pain, corresponding dermatomal hypesthesia, hemiparesis, hemiplegia, paraparesis, paraplegia, and sphincter dysfunction. If the initial symptoms include acute hemiplegia, it is important to differentiate spontaneous spinal epidural hematoma from stroke, tumor, infection, arteriovenous malformation, or autoimmune diseases. We report the case of a 42-year-old man, who visited the emergency department in September, 2006, with the chief complaints of right limbs weakness and neck pain. After the initial work-up, the impression was ischemic stroke. He was admitted for conservative treatment, but his neurological status progressively deteriorated. A cervical MRI showed an epidural hematoma compressing the cervical cord. The patient had emergency decompression surgery. Muscle power in the right limbs improved after surgery, and he could independently perform all activities of daily living after rehabilitative training. The prognosis of acute spontaneous spinal epidural hematoma depends on early diagnosis and proper management. Comprehensive rehabilitation also plays a key role in regaining function in this patient population.

並列關鍵字

spontaneous spinal epidural hematoma ； acute myelopathy ； cerebral vascular accident ； cervical spine ； epidural hematoma ； hemiparesis

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急性自發性頸椎硬腦膜外血腫致右側肢體無力：病例報告

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