Experience in Management of a Case With Spontaneous Onset of High-Level Cervical Cord Infarction Accompanied With Sleep Apnea

自發型高頸椎栓塞病患合併呼吸中止症狀之治療經驗

黎桂珍(Kuei-Chen Lee) ； 陳良城(Liang-Cheng Chen) ； 張幸初(Shin-Tsu Chang)

《物理治療》 43卷4期 (2018/12) Pp. 283-288

https://doi.org/10.6215/FJPT.201812_43(4).0006

摘要

Background and Purpose: Spontaneous spinal cord infarction accompanied with sleep apnea is an uncommon clinical manifestation. Most spinal cord infarction occurs following invasive procedures or trauma. This case report illustrated the clinical presentation, diagnosis, management, and prognosis of a case of C2-C5 spontaneous spinal cord infarction. Case Description: A 38-year-old woman experienced sudden onset muscle weakness in all 4 limbs accompanied with sleep apnea. A magnetic resonance imaging revealed partial occlusion of the anterior cervical spinal artery, and we established a diagnosis of acute C2-C5 spinal cord infarction. The neurologist immediately started steroid and anticoagulant treatment. One month after the onset, the rehabilitation department was consulted owing to persistent tetraplegia and difficulty in weaning off the ventilator. Physical therapy interventions included diaphragm training, facilitative techniques and strengthening exercises for limbs. Results: After a 2-week respiratory training, the patient was successfully weaned off the ventilator. Four months after the onset of symptoms, the patient could walk independently with a walker, but was still unable to urinate without difficulty. Conclusions: Compared with other similar cases, our case had better clinical outcomes. Partial preservation of spinal artery and accurate early diagnosis are critical for patient prognosis. Appropriate physical therapy interventions are also beneficial for better recovery in muscle strength and function abilities.

關鍵字

Spontaneous spinal cord infarction ； Sleep apnea ； Weaning off ventilator

並列摘要

背景與目的：自發性脊髓梗塞伴隨睡眠呼吸中止在臨床上並不常見；大部分脊髓梗塞多發生於侵入性治療或受傷後，本篇病例報告介紹一位自發性頸椎第二到第五節梗塞病患之臨床表現、處置及預後。個案描述：38歲女性病患突然發生四肢無力伴隨睡眠呼吸中止，磁振照影顯示前頸脊動脈有部分阻塞診斷為急性脊髓梗塞，因此神經內科醫師立即給予類固醇及抗凝血劑治療，病發一個月後個案仍四肢無力且依賴呼吸器，故會診復健科，物理治療的介入訓練包括橫膈肌加強、四肢的誘發及肌力訓練等；結果：經過2週物理治療呼吸訓練後，個案成功脫離呼吸器，四肢肌力也逐漸恢復；在病發的4個月後，個案可拿助行器獨立行走，但解尿仍有困難。結論：搜尋相關文獻發現，相較於其他類似個案，本個案功能預後較佳，脊動脈只有部分梗塞，除了早期確診給予抗凝血治療為主要原因外，物理治療的適當介入也有助於本個案功能及肌力的恢復。

並列關鍵字

自發性高位頸髓梗塞 ； 睡眠呼吸中止 ； 物理治療介入