脊髓內星狀細胞瘤以頸背痛症狀呈現：病例報告

Intramedullary Astrocytoma Presenting As Cervical and Upper Back Pain: A Case Report

楊照彬(Chao-Pin Yang) ； 鄭均洹(Chun-Yuan Cheng) ； 李英玄(Ying-Hsuan Li)

《台灣復健醫學雜誌》 41卷1期 (2013/03) Pp. 69-76

https://doi.org/10.6315/2013.41(1)08

摘要

脊髓內星狀細胞瘤是很少見的疾病，約佔中樞神經系統星狀細胞瘤的3%，臨床症狀多變而常以疼痛表現，從發病到診斷被確定多需數個月到數年的時間。脊髓內星狀細胞瘤和頸椎間盤突出可能同時存在，因為初期症狀相似，容易造成臨床醫師誤以為單純之頸椎間盤突出而忽略掉脊髓內星狀細胞瘤的存在。本篇報告一位30歲男性因頸部及上背痛的症狀求診，疼痛延伸至右上肢。開始診斷為頸神經根病變，接受兩個月復健治療獲得良好的療效，但經過一個月後症狀再次復發，此次對復健治療反應差且逐漸出現嚴重的疼痛加劇，夜間疼痛及神經功能喪失，包含右側軀幹及上肢的痛覺及溫覺喪失，右手無力，深肌腱反射增加。核磁共振檢查發現頸椎第5第6節之間的椎間盤突出，以及頸椎第四節到胸椎第七節的脊髓內腫瘤合併脊髓空洞症，由於腫瘤為浸潤型，因此無法完全切除腫瘤而僅予切片檢查，病理報告為分化不良型星狀細胞瘤，治療計畫改為放射線治療及化學治療，治療後6個月的核磁共振追蹤顯示脊髓空洞減小，脊髓內腫瘤已完全消失。患者的疼痛改善，軀幹及上肢痛覺及溫覺回復正常，右上肢的肌力改善。本報告針對頸神經根病變的鑑別診斷和脊髓內星狀細胞瘤之臨床表現及治療作相關性探討和文獻回顧，以供臨床醫師參考。

關鍵字

頸神經根病變（cervical radiculopathy） ； 脊髓內星狀細胞瘤（intramedullary astrocytoma） ； 分化不良型星狀細胞瘤（anaplastic astrocytoma）

並列摘要

Intramedullary astrocytomas are rare, accounting for 3% of all central nervous system astrocytomas. Pain is the most common clinical symptom, although symptoms can vary. These tumors typically progress over a period of months to years before the diagnosis is established. An intramedullary astrocytoma and cervical intervertebral disc herniation may coexist; the early symptoms maybe similar and an intramedullary astrocytoma might go undetected and be misdiagnosed as cervical disc herniation. This paper reports a 30-year-old male who presented with cervical and upper back pain extending to the right upper limb. Initially, the diagnosis was a cervical radiculopathy. After rehabilitation, for two months, the patient improved. However, the symptoms recurred one month later. This time, the response to rehabilitation was unsatisfactory and the pain increased in severity, now including night pain and loss of neurological function, including loss of pain and temperature sensation in the right trunk and upper limb, right hand weakness, as well as increased deep tendon reflexes. Magnetic resonance imaging (MRI) led to the diagnosis of cervical intervertebral disc herniation (C5-6), and a cervical and thoracic intramedullary tumor (C4-T7) with syringomyelia. Because the tumor was infiltrative, a total gross resection could not be accomplished, and therefore only a biopsy was performed. Pathological examination confirmed the diagnosis of an anaplastic astrocytoma. Six months after completion of radiotherapy and chemotherapy, the follow-up MRI showed that the syrinx had decreased and the intramedullary tumor could not be visualized. The cervical and upper back pain decreased. Pain and temperature sensation of the trunk and upper limb recovered and the right upper limb regained strength. Here, the differential diagnosis of cervical radiculopathy is discussed as well as the clinical presentation and treatment of intramedullary astrocytomas with a review of the relevant literature.

並列關鍵字

cervical radiculopathy ； intramedullary astrocytoma ； anaplastic astrocytoma