Non-traumatic Spinal Cord Injury in a Young Patient: A Case Report

年輕患者發生非外傷性脊髓損傷：病例報告

張志任(Chih-Zen Chang)

《南臺灣醫學雜誌》 16卷1期 (2020/06) Pp. 28-33

https://doi.org/10.6726/MJST.202006_16(1).0004

摘要

Non-traumatic spinal cord injury (ntSCI) is supposed to occur in the elder, female and retired individuals but rare in the young men. We report a 40-year-old man with ntSCI bracketed with unexpected neurogenic shock. The patient visited the emergent department owing to fever and neck tightness on the 7th July, 2019. Under the diagnosis of right lower lobe pneumonia, he was admitted to the infection ward for empiric antibacterial therapy. Two days after admission, a catastrophic respiratory collapse associated with tetraplegia happened. Intubation was performed immediately and ventilation support was offered. Cervical MRI revealed C2,3,4,5,6,7 edematous cord with suspected intramedullary subarachnoid hemorrhage. Surgical intervention enrolled C2-7 laminectomy. Posterior neurologic decompression did achieve a little outcome including improved muscle power and respiratory failure let alone a major neurologic deficit. This study lends credence to support accurate diagnosis of ntSCI, and an optimal surgical management wound heads the patients to a better result in no time once the diagnosis of SCI was impressed.

關鍵字

Non-traumatic ； neurologic decompression ； spinal cord injury ； spinal shock

並列摘要

非外傷性脊髓損傷是一種較常發生在年長，退休的族群身上，發生在年輕患者是非常少見的。關於非外傷性或自發性的脊髓損傷報導非常少，追究其原因不外是確切病因無法獲知，無標準治療和預防方法，預後不佳。根據文獻定義自發性的脊髓損傷是排除因外傷引起的脊髓神經傷害，造成原因不外乎血管梗塞、腫瘤、感染、糖尿病及自體免疫疾患造成。本病歷為一40歲男性，過去病史包括酒精性胰臟炎、第二型糖尿病，接受治療，患者造訪急診的目的為脖子痠痛及發燒，放射線檢查為右下葉肺炎及正常的腦斷層檢查。入院接受抗生素治療。入院後兩天，患者突發呼吸衰竭及四肢癱瘓，而接受緊急頸椎核磁共振檢查。檢查結果顯示第二至七頸椎脊髓水腫，疑脊髓內血腫。手術治療包含第二至七頸椎椎板切除固定手術。術後患者殘存肢體的障礙，右下肢肌力可達兩分，再次核磁共振檢查顯示脊髓水腫已慢慢消解。因此這個病人給我們的啟示，對於非外傷性脊髓損傷的疾患，應早日發現，確診並積極手術治療及積極的復健，才能改善患者生理的不幸。唯一的缺陷是此患者為何發生脊髓損傷？是因為糖尿病或肺部感染引起，莫衷於是。

並列關鍵字

非外傷性 ； 神經減壓 ； 脊髓損傷 ； 脊髓休克